Provider Demographics
NPI:1932298155
Name:GREEN, ROBERT F (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-0527
Mailing Address - Country:US
Mailing Address - Phone:330-467-3902
Mailing Address - Fax:
Practice Address - Street 1:38600 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:N RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2837
Practice Address - Country:US
Practice Address - Phone:330-467-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1982213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0444522Medicaid
OHT91959Medicare UPIN
OHGR0482172Medicare ID - Type UnspecifiedDPM