Individual
DR. GORDON MARTIN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
295 COMMONWEALTH BLVD W, MARTINSVILLE, VA 24112-1820
(276) 638-2311
(276) 638-3537
Mailing address
1020 CORN TASSEL TRL, MARTINSVILLE, VA 24112-5606
(276) 666-4474
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101052580
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010362661
—
VA
Enumeration date
03/31/2006
Last updated
08/21/2008
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