Individual
MARK GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
90 CONCORD AVE, BELMONT, MA 02478-4046
(857) 598-2808
(857) 598-2864
Mailing address
90 CONCORD AVE, BELMONT, MA 02478-4046
(857) 598-2808
(857) 598-2864
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
222713
MA
2084P0800X
Psychiatry Physician
Primary
222713
MA
2084P0802X
Addiction Psychiatry Physician
222713
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021927
KAISER COMMERCIAL NUMBER
CO
05
—
41035810
—
CO
Enumeration date
04/24/2007
Last updated
07/15/2015
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