Provider Demographics
NPI:1487766952
Name:GREEN, LINDA DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:DIANE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:D
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:850 W CHESTER PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4400
Mailing Address - Country:US
Mailing Address - Phone:610-446-4844
Mailing Address - Fax:610-446-3901
Practice Address - Street 1:850 W CHESTER PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4439
Practice Address - Country:US
Practice Address - Phone:610-446-4844
Practice Address - Fax:610-446-3901
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020354E207K00000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2571967OtherUNITED HEALTHCARE
PA0036284000OtherINDEPENDENCE BLUE CROSS
PA232571967OtherAETNA
PA232571967OtherGUARDIAN
PA4577294OtherAETNA HMO
PAA92498OtherAMERIHEALTH ADMINISTRATOR
PA5648713OtherCIGNA HMO
PA30102OtherKEYSTONE MERCY HEALTH PLA
PA192498OtherBLUE SHIELD
PA232571967OtherHEALTH AMERICA
PA000844653Medicaid
PA232571967OtherBENEFIT CONCEPTS
PA232571967OtherCIGNA
PA787324OtherFIRST HEALTH
PA232571967OtherGUARDIAN
PA4577294OtherAETNA HMO
PA232571967OtherAETNA