MEDICARE: DR. ALLEN GREEN JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	U4809	TX
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	FG3002514	OH

General Provider Information

NPI Number	:	1043848260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN GREEN JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 THOMAS LN STE 3A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1419
Country	:	US
Telephone Number	:	843-331-8330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	05/15/2026

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