Provider Demographics
NPI:1902094303
Name:GREEN, ANGELA (RD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MARKET ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2881
Mailing Address - Country:US
Mailing Address - Phone:740-284-1775
Mailing Address - Fax:740-284-1749
Practice Address - Street 1:1805 SINCLAIR AVE
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3327
Practice Address - Country:US
Practice Address - Phone:740-266-4940
Practice Address - Fax:740-266-4981
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP10253-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMT03981Medicare PIN