Provider Demographics
NPI:1932364965
Name:RODNEY ALLAN GREEN
Entity Type:Organization
Organization Name:RODNEY ALLAN GREEN
Other - Org Name:DR. RODNEY A. GREEN M.D. FACS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-449-8880
Mailing Address - Street 1:PO BOX 18554
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-0554
Mailing Address - Country:US
Mailing Address - Phone:440-449-8880
Mailing Address - Fax:440-449-8640
Practice Address - Street 1:5035 MAYFIELD RD
Practice Address - Street 2:STE 100
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2688
Practice Address - Country:US
Practice Address - Phone:440-449-8880
Practice Address - Fax:440-449-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0659836Medicaid
OHA17051Medicare UPIN
OH9299121Medicare PIN