Provider Demographics
NPI:1275767766
Name:PATEL, MARTHA GRACE GREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:GRACE GREEN
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:GRACE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2519 OAKCREST AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4707
Mailing Address - Country:US
Mailing Address - Phone:336-271-2007
Mailing Address - Fax:336-271-2904
Practice Address - Street 1:2519 OAKCREST AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4707
Practice Address - Country:US
Practice Address - Phone:336-271-2007
Practice Address - Fax:336-271-2904
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013009585207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology