Provider Demographics
NPI:1639139942
Name:GREEN, REBECCA S (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:280 MAIN ST
Mailing Address - Street 2:SUITE 131
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2921
Mailing Address - Country:US
Mailing Address - Phone:603-882-0555
Mailing Address - Fax:603-882-0360
Practice Address - Street 1:280 MAIN ST
Practice Address - Street 2:SUITE 131
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2921
Practice Address - Country:US
Practice Address - Phone:603-882-0555
Practice Address - Fax:603-882-0360
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH5782207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHE17072OtherHARVARD PILGRIM
NH30203933Medicaid
MARE0579OtherBCBSMA
MA005782OtherTUFTS HEALTH PLAN
NH0104789Y0NH02OtherANTHEM BCBS NH
NH074575OtherUNITED HEALTHCARE
NH3311OtherHEALTHSOURCE NH
NH3406995OtherAETNA HEALTHCARE
NH782998OtherMVP HEALTH PLAN
NH782998OtherMVP HEALTH PLAN
NH3311OtherHEALTHSOURCE NH
NHP00108636Medicare ID - Type UnspecifiedRAILROAD MEDICARE