Provider Demographics
NPI:1528025251
Name:GREEN, THOMAS ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROGER
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:185 LINCOLN ST
Mailing Address - Street 2:STE 210
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-740-2349
Mailing Address - Fax:781-740-2349
Practice Address - Street 1:185 LINCOLN ST
Practice Address - Street 2:STE 210
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-740-2349
Practice Address - Fax:781-740-2349
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA550942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
008934OtherUNITED HEALTHCARE
055589000OtherMAGELLAN
T1499530OtherOXFORD HEALTH
008934OtherUNITED BEHAVIORAL HEALTH
223051OtherMANAGED HEALTH NETWORK
104021500OtherDEPT OF LABOR
74746020OtherFIRST HEALTH
82782OtherUS HEALTHCARE
J06455OtherBCBS
002301OtherHARVARD PILGRIM
008934OtherVALUE OPTIONS
223051OtherMANAGED HEALTH NETWORK
055589000OtherMAGELLAN