Provider Demographics
NPI:1912956616
Name:GREEN, DONALD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MICHAEL
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:35 COPELAND AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3302
Mailing Address - Country:US
Mailing Address - Phone:781-944-8455
Mailing Address - Fax:781-942-0253
Practice Address - Street 1:35 COPELAND AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3302
Practice Address - Country:US
Practice Address - Phone:781-944-0600
Practice Address - Fax:781-942-0253
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA34782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2059975Medicaid
MAB30155Medicare ID - Type Unspecified