MEDICARE: MARTINA A GREEN-MCGOWAN M.D.

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	207V00000X	Obstetrics & Gynecology Physician	01041734	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295739639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTINA A GREEN-MCGOWAN M.D.

Provider Business Mailing Address
First Line	:	236 SIMPSON AVE
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-4666
Country	:	US
Telephone Number	:	574-293-0052
Fax Number	:	574-293-3744

Provider Business Practice Location Address
First Line	:	236 SIMPSON AVE
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516
Country	:	US
Telephone Number	:	574-293-0052
Fax Number	:	574-293-3744

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/18/2019

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