Provider Demographics
NPI:1831280213
Name:GREEN, RODNEY ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ALLAN
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18554
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-0554
Mailing Address - Country:US
Mailing Address - Phone:440-449-8880
Mailing Address - Fax:440-449-8640
Practice Address - Street 1:5035 MAYFIELD RD
Practice Address - Street 2:STE 100
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2688
Practice Address - Country:US
Practice Address - Phone:440-449-8880
Practice Address - Fax:440-449-8640
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049964174400000X, 208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0659836Medicaid
OH0659836Medicaid
OH9299121Medicare PIN