Individual
PATRICK GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
267 OCEAN AVE, PORTLAND, ME 04103-5707
(207) 756-9188
Mailing address
36A MAPLEWOOD ST, PORTLAND, ME 04103-3604
(207) 756-9188
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AT625
ME
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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