Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MD011917E | PA |
NPI | 1164427480 |
---|---|
Provider Name | Dr. Richard L. Green |
First Address | Pittsburgh, PA 15222-1102 |
Second Address | Pittsburgh, PA 15222-1102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 08/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006558160002 | (05) | PA |
C32157 | (02) | PA |