Provider Demographics
NPI:1255460887
Name:HAROLD T GREEN JR MD PC
Entity type:Organization
Organization Name:HAROLD T GREEN JR MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:T
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-329-8510
Mailing Address - Street 1:2421 CHAMBERLAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-4205
Mailing Address - Country:US
Mailing Address - Phone:804-329-8510
Mailing Address - Fax:804-329-2160
Practice Address - Street 1:2421 CHAMBERLAYNE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-4205
Practice Address - Country:US
Practice Address - Phone:804-329-8510
Practice Address - Fax:804-329-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030494173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255460887OtherGROUP NPI
VADD1393OtherRAILROAD MEDICARE
VADD1393OtherRAILROAD MEDICARE