MEDICARE: DR. THOMAS E GREEN 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	207Q00000X	Family Medicine Physician	35-05-5463-G	OH

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	:	1487655320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS E GREEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 637676
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	513-923-1886
Fax Number	:	513-923-2878

Provider Business Practice Location Address
First Line	:	7631 CHEVIOT RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-4012
Country	:	US
Telephone Number	:	513-923-1886
Fax Number	:	513-923-2878

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	05/23/2012

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