Provider Demographics
NPI:1427120344
Name:GREEN, ALLAN M (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:M
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2009
Mailing Address - Country:US
Mailing Address - Phone:617-447-5999
Mailing Address - Fax:
Practice Address - Street 1:124 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 200N
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5813
Practice Address - Country:US
Practice Address - Phone:617-447-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine