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General NPI Number Information
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NPI Number | 1487766952
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Entity Type | Individual
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Provider Name | LINDA DIANE GREEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 850 W CHESTER PIKE SUITE 300
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City | HAVERTOWN
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State | PA
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Zip | 19083-4439
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Country | US
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Telephone | 610-446-4844
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Fax | 610-446-3901
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Provider Business Mailing Address
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Address Line | 850 W CHESTER PIKE SUITE 300
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City | HAVERTOWN
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State | PA
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Zip | 19083-4400
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Country | US
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Telephone | 610-446-4844
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Fax | 610-446-3901
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MD020354E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | MD020354E
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License Number State | PA
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