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1639251515

NPI Code Detail

MEDICARE: LIZA B GREEN MD

MEDICARE: LIZA B 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	208100000X	Physical Medicine & Rehabilitation Physician	4301074888	MI
2	208100000X	Physical Medicine & Rehabilitation Physician	MD459902	PA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639251515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZA B GREEN MD

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	480 CENTRAL RD
Second Line	:
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-3121
Country	:	US
Telephone Number	:	570-387-6150
Fax Number	:	570-387-6185

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	03/03/2022

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Directions to “ LIZA B GREEN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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