Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | MD032064E | PA |
NPI | 1114990017 |
---|---|
Provider Name | Michael Green |
First Address | Pittsburgh, PA 15213-3205 |
Second Address | Pittsburgh, PA 15213-3205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E27387 | (02) | PA |