Provider Demographics
NPI:1669608378
Name:SPENCER-GREEN, GEORGE THOMAS (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
Last Name:SPENCER-GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WAVERLY ST
Mailing Address - Street 2:VERTEX CORP
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4242
Mailing Address - Country:US
Mailing Address - Phone:617-444-6398
Mailing Address - Fax:
Practice Address - Street 1:130 WAVERLY ST
Practice Address - Street 2:VERTEX CORP
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4242
Practice Address - Country:US
Practice Address - Phone:617-444-6398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.038952207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology