MEDICARE: MRS. MEGAN MARIE GREEN RDMS RVT

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	2471S1302X	Sonography Radiologic Technologist	117328	FL
2	2471V0105X	Vascular Sonography Radiologic Technologist	117328	FL

General Provider Information

NPI Number	:	1740576412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN MARIE GREEN RDMS RVT

Provider Business Mailing Address
First Line	:	2106 CARROLL GARDENS LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-5012
Country	:	US
Telephone Number	:	813-731-7472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 CARROLL GARDENS LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-5012
Country	:	US
Telephone Number	:	813-731-7472
Fax Number	:

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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