Ronald W Green Jr., PA
Individual provider Active NPI Specialist · Beaver, WV
NPI 1366432601 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366432601
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 213 (WV)
- Practice address
- 703 Ritter Drive
Beaver, WV 25813 - Phone
- (304) 255-1300
- Fax
- (304) 255-5391
- NPI assigned
- Oct 27, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 213 | WV | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 213 | WV | Yes |
Addresses
Primary practice location
703 Ritter Drive
Beaver, WV 25813
Mailing address
PO Box 550
Beaver, WV 25813-0550
Phone (304) 255-1300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001720686 | Other | WV | BLUE CROSS |
| 2103752 | Other | WV | MAMSI |
Other providers in Beaver, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.