Provider Demographics
NPI:1811043664
Name:GREEN, DARIN L (DO)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:L
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4500
Mailing Address - Country:US
Mailing Address - Phone:937-222-2096
Mailing Address - Fax:937-222-2946
Practice Address - Street 1:300 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4500
Practice Address - Country:US
Practice Address - Phone:937-222-2096
Practice Address - Fax:937-222-2946
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005569208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0187640Medicaid
OH0186721Medicaid
OH0744712Medicare PIN
F62928Medicare UPIN