Provider Demographics
NPI:1639363831
Name:BETH F GREEN, M.D., INC
Entity Type:Organization
Organization Name:BETH F GREEN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-399-9009
Mailing Address - Street 1:250 ALMENDRA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7211
Mailing Address - Country:US
Mailing Address - Phone:408-399-9009
Mailing Address - Fax:408-399-9073
Practice Address - Street 1:250 ALMENDRA AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7211
Practice Address - Country:US
Practice Address - Phone:408-399-9009
Practice Address - Fax:408-399-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E899830Medicare UPIN