Provider Demographics
NPI:1255382339
Name:GREEN, CHARLENE EDWARDS (MD)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:EDWARDS
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3625 N ELM ST
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2604
Mailing Address - Country:US
Mailing Address - Phone:336-282-4840
Mailing Address - Fax:336-282-4660
Practice Address - Street 1:3625 N ELM ST
Practice Address - Street 2:SUITE 110A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2604
Practice Address - Country:US
Practice Address - Phone:336-282-4840
Practice Address - Fax:336-282-4660
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2018-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9300690207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8960433Medicaid
VA5701007Medicaid
NC60433OtherBCBS
NC8960433Medicaid
NC60433OtherBCBS