Provider Demographics
NPI:1952331340
Name:GREEN, DAVID EMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EMANUEL
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 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-251-8824
Practice Address - Street 1:1202 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7307
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-8824
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236921207R00000X
NC2007-01734207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87834596Medicaid
TX8HD806Medicare ID - Type UnspecifiedHSZ197
TX8HD803Medicare ID - Type UnspecifiedHSZ003
TX8HD805Medicare ID - Type UnspecifiedHSZ006
TX8HD801Medicare ID - Type UnspecifiedHSZ001
TX8HD804Medicare ID - Type UnspecifiedHSZ005
NM87834596Medicaid
I30702Medicare UPIN