Healthcare Provider Details

I. General information

NPI: 1669404869
Provider Name (Legal Business Name): DINA E GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 222 MOB SOUTH
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE SUITE 222 MOB SOUTH
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 610-649-1922
  • Fax: 610-649-2121
Mailing address:
  • Phone: 610-649-1922
  • Fax: 610-649-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD072071L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: