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General NPI Number Information
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NPI Number | 1356440754
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Entity Type | Individual
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Provider Name | BRAD EVAN GREEN DO
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/15/2018
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Provider Practice Location Address
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Address Line | 45 WELLS ST STE 204
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City | WESTERLY
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State | RI
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Zip | 02891-2927
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Country | US
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Telephone | 401-637-7929
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Fax | 860-865-2242
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Provider Business Mailing Address
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Address Line | 47 COLLEGE ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3209
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Country | US
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Telephone | 401-637-7929
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Fax | 860-865-2242
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 56273
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | DO00392
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 61746
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License Number State | CT
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