Provider Demographics
NPI:1477686905
Name:GREEN, RAYMOND HOWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:HOWARD
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:MAP 2, SUITE 3301
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4735 OGLETOWN STANTON ROAD
Practice Address - Street 2:MEDICAL ARTS PAVILION 2, SUITE 3301
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-623-4370
Practice Address - Fax:856-342-2817
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC7-0002936208600000X
NJMB088390002086S0102X
DEC2-00118222086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMB08839000OtherSTATE LICENSE