Individual
DR. JOHN CHARLES GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6481 CARLISLE PIKE, MECHANICSBURG, PA 17050-2377
(717) 516-6396
(717) 620-8093
Mailing address
6481 CARLISLE PIKE, MECHANICSBURG, PA 17050-2377
(717) 516-6396
(717) 620-8093
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
34 00 5210
OH
208600000X
Surgery Physician
Primary
OS 005621 L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000181658
UNISON MEDICAID
OH
05
—
001007392
—
PA
05
—
0125294000
—
OH
01
—
1528015591
NPI
—
01
—
2055449
MOLINA MEDICAID
OH
01
—
310917085084
CARESOURCE MEDICAID
OH
01
—
P00284946
RR MEDICARE
—
Enumeration date
05/27/2006
Last updated
01/08/2021
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