Provider Demographics
NPI:1518429836
Name:GREEN, ELLEN WALFORD (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:WALFORD
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 1:4107B BIOINFORMATICS 130 MASON FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7080
Mailing Address - Country:US
Mailing Address - Phone:919-966-2514
Mailing Address - Fax:919-966-6842
Practice Address - Street 1:4119B BIOINFORMATICS BUILDING 130 MASON FARM ROAD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-966-2514
Practice Address - Fax:919-966-6842
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG205825390200000X
NMRS2022-0794390200000X
NC2023-01815390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program