Provider Demographics
NPI:1689698441
Name:GREEN, ALAN HILLEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:HILLEL
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:STE 470
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1629
Mailing Address - Country:US
Mailing Address - Phone:617-232-1752
Mailing Address - Fax:617-566-3919
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-232-1752
Practice Address - Fax:617-566-3919
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1679213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0360937Medicaid
MAGRY70763Medicare ID - Type Unspecified
MA0360937Medicaid