| Doctor Name: | DR. BRANDON MICHAEL GREEN |
| NPI Number: | 1669609160 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 2200 |
| Business Practice Address: | 295 Columbia Rd Boston, MA - 021213409 |
| Business Phone Number: | 6174366110 |
| Business Fax Number: | 6174362424 |
| Mailing Address: | 295 Columbia Rd, BOSTON |
| State: | MA |
| Postal Code: | 021213409 |
| Phone Number: | 6174366110 |
| Fax Number: | 6174362424 |
| NPI Enumeration Date: | 06/11/2009 |
| NPI Last Update Date: | 09/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 2200 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |