Provider Demographics
NPI:1124232954
Name:GREEN, JAMI E (MD)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 FIRST AVENUE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-529-0483
Mailing Address - Fax:304-781-2687
Practice Address - Street 1:2828 FIRST AVENUE
Practice Address - Street 2:SUITE 510
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-529-0483
Practice Address - Fax:304-781-2687
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH288002OtherMEDICAID - CHHI
7411361OtherMEDICARE - CHHI
KY7100066490Medicaid
WV9347204OtherAETNA
WV3810013111Medicaid
WV4250011Medicare PIN
WV3810013111Medicaid