Provider Demographics
NPI:1780689091
Name:GREEN, LOUIS MAYER (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:MAYER
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1668
Mailing Address - Country:US
Mailing Address - Phone:315-479-5070
Mailing Address - Fax:315-701-2550
Practice Address - Street 1:1001 W FAYETTE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2859
Practice Address - Country:US
Practice Address - Phone:315-472-1488
Practice Address - Fax:315-472-8060
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2016-10-14
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Provider Licenses
StateLicense IDTaxonomies
NY131887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00625434Medicaid
J400027541Medicare PIN
NY34085BMedicare ID - Type Unspecified
NY00625434Medicaid
NYD02148Medicare UPIN