Individual
DR. JONATHAN S GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607
(919) 784-7093
(919) 784-7395
Mailing address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-7093
(919) 784-7395
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
200100242
NC
208M00000X
Hospitalist Physician
200100242
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128U7
BCBS
—
05
—
89128U7
—
NC
Enumeration date
12/27/2005
Last updated
03/07/2023
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