MEDICARE: ROBERT ALLEN GREEN 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	207X00000X	Orthopaedic Surgery Physician	017732	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010017732CT01	OTHER	CT	ANTHEM/BCBS

General Provider Information

NPI Number	:	1578554499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ALLEN GREEN MD

Provider Business Mailing Address
First Line	:	421 COTTAGE GROVE RD
Second Line	:	SUITE A
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3170
Country	:	US
Telephone Number	:	860-286-0182
Fax Number	:	860-286-7839

Provider Business Practice Location Address
First Line	:	421 COTTAGE GROVE RD
Second Line	:	SUITE A
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3170
Country	:	US
Telephone Number	:	860-286-0182
Fax Number	:	860-286-7839

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	02/11/2013

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