MEDICARE: JENNIFER A GREEN M.D.

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	207V00000X	Obstetrics & Gynecology Physician	35075307	OH

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

General Provider Information

NPI Number	:	1811989361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A GREEN M.D.

Provider Business Mailing Address
First Line	:	157 LINDEN DR
Second Line	:
City	:	WYOMING
State	:	OH
Zip	:	45215-4204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 AUBURN AVE
Second Line	:	528
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2906
Country	:	US
Telephone Number	:	513-792-5800
Fax Number	:	513-792-5806

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/08/2007

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