Provider Demographics
NPI:1063829620
Name:GREEN, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 PARAMOUNT DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-5416
Mailing Address - Country:US
Mailing Address - Phone:508-880-0012
Mailing Address - Fax:
Practice Address - Street 1:675 PARAMOUNT DR
Practice Address - Street 2:SUITE 203
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-5416
Practice Address - Country:US
Practice Address - Phone:508-880-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant