Individual
GARY RANDALL GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 EAST ADAMS ST, SYRACUSE, NY 13210
(315) 464-1800
(315) 464-6238
Mailing address
251 SALINA MEADOWS PKWY STE 100, SYRACUSE, NY 13212-4516
(315) 464-2000
(315) 464-2010
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
224487
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02256848
—
NY
Enumeration date
07/08/2005
Last updated
07/21/2022
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