Individual
IVAN R GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 GOLD STAR BLVD, WORCESTER, MA 01606
(508) 853-2716
(508) 856-9025
Mailing address
630 PLANTATION ST, WORCESTER, MA 01605-2038
(508) 853-2716
(508) 856-9025
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36946
MA
Other
Enumeration date
05/17/2006
Last updated
02/13/2009
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