Provider Demographics
NPI:1790867034
Name:GREEN, DANA L (PAC)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:L
Last Name:GREEN
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:ELLSWORTH INTERNAL MEDICINE
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-7780
Mailing Address - Fax:207-664-7721
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:ELLSWORTH INTERNAL MEDICINE
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-664-7780
Practice Address - Fax:207-664-7721
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2018-10-18
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Provider Licenses
StateLicense IDTaxonomies
MEPA-511363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical