Provider Demographics
NPI:1548251853
Name:GREEN, ALEXANDER R (MD MPH)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:R
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION INC
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0909
Mailing Address - Fax:617-724-3843
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2027402Medicaid
MAJ26925OtherBLUE CROSS BLUE SHIELD
MAJ26925OtherBLUE CROSS BLUE SHIELD
MAA36369Medicare ID - Type Unspecified