| Doctor Name: | LAUREL ANNE GREEN |
| NPI Number: | 1043232259 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | MA002776L |
| Business Practice Address: | 100 E Chester Pike Ridley Park, PA - 190781703 |
| Business Phone Number: | 6105213333 |
| Business Fax Number: | 6105212263 |
| Mailing Address: | 100 E Chester Pike, RIDLEY PARK |
| State: | PA |
| Postal Code: | 190781703 |
| Phone Number: | 6105213333 |
| Fax Number: | 6105212263 |
| NPI Enumeration Date: | 07/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA002776L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |