MEDICARE: MARGARET M GREEN RD

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	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001054	OTHER		KAISER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1760522486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET M GREEN RD

Provider Business Mailing Address
First Line	:	10400 E ALAMEDA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-5104
Country	:	US
Telephone Number	:	303-360-1357
Fax Number	:

Provider Business Practice Location Address
First Line	:	10065 E HARVARD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-5968
Country	:	US
Telephone Number	:	303-360-1357
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	11/12/2007

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