Provider Demographics
NPI:1588250377
Name:GREEN, JORAM JOSIAS
Entity type:Individual
Prefix:MR
First Name:JORAM
Middle Name:JOSIAS
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 NORVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2037
Mailing Address - Country:US
Mailing Address - Phone:757-927-8153
Mailing Address - Fax:
Practice Address - Street 1:1232 NORVIEW AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2037
Practice Address - Country:US
Practice Address - Phone:757-927-8153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other