Provider Demographics
NPI:1679641658
Name:GREEN, LAURIE RAE (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:RAE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:316
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-379-9600
Mailing Address - Fax:415-379-9823
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:316
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-379-9600
Practice Address - Fax:415-379-9823
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34865207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46124Medicare UPIN
CA00G348650Medicare ID - Type Unspecified