MEDICARE: NIA ALEXANDRIA 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	207R00000X	Internal Medicine Physician	W5804	TX

General Provider Information

NPI Number	:	1770273492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIA ALEXANDRIA GREEN MD

Provider Business Mailing Address
First Line	:	1133 JOHN FREEMAN BLVD STE 80
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2809
Country	:	US
Telephone Number	:	713-500-6700
Fax Number	:	713-500-6722

Provider Business Practice Location Address
First Line	:	6411 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-6700
Fax Number	:	713-500-6722

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	06/16/2026

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