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NPI Code Detail

MEDICARE: DR. JOHN CHARLES GREEN D.O.

MEDICARE: DR. JOHN CHARLES GREEN D.O.
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
12083S0010XSports Medicine (Preventive Medicine) Physician34 00 5210OH
2208600000XSurgery PhysicianOS 005621 LPA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5P00284946OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21528015591OTHERNPI
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528015591
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN CHARLES GREEN D.O.
Provider Business Mailing Address
First Line : 6481 CARLISLE PIKE
Second Line :
City : MECHANICSBURG
State : PA
Zip : 17050-2377
Country : US
Telephone Number : 717-516-6396
Fax Number : 717-620-8093
Provider Business Practice Location Address
First Line : 6481 CARLISLE PIKE
Second Line :
City : MECHANICSBURG
State : PA
Zip : 17050-2377
Country : US
Telephone Number : 717-516-6396
Fax Number : 717-620-8093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 01/08/2021

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