Provider Demographics
NPI:1801969126
Name:THOMAS L GREEN DO LTD
Entity type:Organization
Organization Name:THOMAS L GREEN DO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-885-5193
Mailing Address - Street 1:688 FRENCHTOWN ROAD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1814
Mailing Address - Country:US
Mailing Address - Phone:401-885-5193
Mailing Address - Fax:401-885-1466
Practice Address - Street 1:688 FRENCHTOWN ROAD
Practice Address - Street 2:SUITE # 1
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1814
Practice Address - Country:US
Practice Address - Phone:401-885-5193
Practice Address - Fax:401-885-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003021Medicaid
089003021Medicare ID - Type Unspecified
D77210Medicare UPIN