Healthcare Provider Details

I. General information

NPI: 1164427480
Provider Name (Legal Business Name): RICHARD L. GREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 FREEPORT RD STE 210
PITTSBURGH PA
15238-1426
US

IV. Provider business mailing address

2585 FREEPORT RD STE 210
PITTSBURGH PA
15238-1426
US

V. Phone/Fax

Practice location:
  • Phone: 412-828-3800
  • Fax: 412-828-8561
Mailing address:
  • Phone: 412-828-3800
  • Fax: 412-828-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD011917E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: