Provider Demographics
NPI:1962524785
Name:GREEN, JENNIFER B (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:20 GUEST ST STE 225
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2065
Mailing Address - Country:US
Mailing Address - Phone:617-491-6766
Mailing Address - Fax:617-491-2552
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:SUTIE 505
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-491-6766
Practice Address - Fax:617-491-2552
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2019-08-07
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Provider Licenses
StateLicense IDTaxonomies
MA2368362086S0105X, 207XS0106X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1962524785Medicare NSC