Individual
MICHAEL D GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
410 WEST MAIN STREET, SOPHIA, WV 25921
(304) 683-4304
Mailing address
217 WOOD ST, BECKLEY, WV 25801-4856
(304) 252-2856
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1040471
NCCPA
WV
Enumeration date
04/10/2007
Last updated
07/08/2007
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