Individual
EDWARD GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
135313
NC
2085R0202X
Diagnostic Radiology Physician
Primary
17833
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179024
—
AL
01
—
512I360002
PTAN
MS
01
—
P01195515
RAILROAD MEDICARE PTAN
MS
Enumeration date
06/27/2007
Last updated
10/06/2022
Update your record
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