Provider Demographics
NPI:1912040478
Name:GREEN, HOWARD H (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:H
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 ALLEN FARM LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2202
Mailing Address - Country:US
Mailing Address - Phone:978-371-0641
Mailing Address - Fax:
Practice Address - Street 1:73 ALLEN FARM LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2202
Practice Address - Country:US
Practice Address - Phone:978-371-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine