Provider Demographics
NPI:1427169044
Name:GREEN, HAROLD T JR (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:T
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2421 CHAMBERLAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-4205
Mailing Address - Country:US
Mailing Address - Phone:804-321-4513
Mailing Address - Fax:804-329-2160
Practice Address - Street 1:2421 CHAMBERLAYNE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-4205
Practice Address - Country:US
Practice Address - Phone:804-321-4513
Practice Address - Fax:804-329-2160
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101030494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA46320OtherAETNA
VA813839OtherMAMSI
VAV6046029OtherVIRGINIA COORDINATED CARE
VA110054353OtherRAILROAD MEDICARE
VAC03017OtherGROUP PTAN
VA46320OtherUNITED HEALTHCARE
VA006046029Medicaid
VA44128OtherOPTIMA HEALTH
VA44128OtherSENTARA
VA57991OtherSOUTHERN HEALTH
VA006046029OtherVIRGINIA PREMIER
VA094290OtherANTHEM BC/BS
VA30291OtherCARENET
VAC06695OtherGROUP PTAN
VAV6046029OtherVIRGINIA COORDINATED CARE
VAC03017OtherGROUP PTAN