Healthcare Provider Details

I. General information

NPI: 1255460887
Provider Name (Legal Business Name): HAROLD T GREEN JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 CHAMBERLAYNE AVE
RICHMOND VA
23222-4205
US

IV. Provider business mailing address

2421 CHAMBERLAYNE AVE
RICHMOND VA
23222-4205
US

V. Phone/Fax

Practice location:
  • Phone: 804-329-8510
  • Fax: 804-329-2160
Mailing address:
  • Phone: 804-329-8510
  • Fax: 804-329-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0101030494
License Number StateVA

VIII. Authorized Official

Name: DR. HAROLD T GREEN JR.
Title or Position: PHYSICIAN
Credential: MD
Phone: 804-329-8510