Provider Demographics
NPI:1114196995
Name:GREEN, ANGELA E (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 CLEVELAND PL
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-1021
Mailing Address - Country:US
Mailing Address - Phone:504-430-2136
Mailing Address - Fax:
Practice Address - Street 1:9900 LAKE FOREST BLVD STE F
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2609
Practice Address - Country:US
Practice Address - Phone:504-620-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361665852084P0800X
LADO.0001572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1038024Medicaid
LA1925349Medicaid
LA1444642Medicaid