Individual
MARY ETOSHA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 646-1222
(866) 623-8110
Mailing address
PO BOX 844770, BOSTON, MA 02284-4770
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
74633
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2018
Last updated
08/14/2023
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