Individual
DR. REBECCA SHAW GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115
(617) 355-6624
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6624
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
278290
MA
208000000X
Pediatrics Physician
MD464196
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1034904090001
—
PA
Enumeration date
06/04/2015
Last updated
06/28/2019
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