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NPI Code Detail

MEDICARE: HAROLD T GREEN JR MD PC

MEDICARE: HAROLD T GREEN JR MD PC
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
1173000000XLegal Medicine0101030494VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DD1393OTHERVARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11255460887OTHERVAGROUP NPI

General Provider Information

NPI Number : 1255460887
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAROLD T GREEN JR MD PC
Provider Business Mailing Address
First Line : 2421 CHAMBERLAYNE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23222-4205
Country : US
Telephone Number : 804-329-8510
Fax Number : 804-329-2160
Provider Business Practice Location Address
First Line : 2421 CHAMBERLAYNE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23222-4205
Country : US
Telephone Number : 804-329-8510
Fax Number : 804-329-2160
Authorized Official
Title or Position : PHYSICIAN
Name : DR. HAROLD T GREEN JR.
Credential : MD
Telephone Number : 804-329-8510
Provider Enumeration Date : 03/02/2007
Last Update Date : 03/31/2010

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