Andrea Elizabeth Green, M.D.
Individual provider Active NPI Pediatrics Physician · Burlington, VT
NPI 1649286451 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1649286451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 042-0010520 (VT)
- Practice address
- 1 South Prospect Street
Uhc Pediatrics
Burlington, VT 05401 - Phone
- (802) 847-4696
- NPI assigned
- Aug 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130718000325 | VT | Practitioner - Pediatric Medicine | 6901047810 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0010520 | VT | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Vermont Medical Center Inc | Pediatrics | Current |
Accepting new patients |
Locations
1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531
Interoperability endpoints
- agreen3962@direct.uvmhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 042-0010520 | VT | Yes |
Addresses
Primary practice location
1 South Prospect Street
Uhc Pediatrics
Burlington, VT 05401
Mailing address
239 Ridge Rd
Charlotte, VT 05445-9071
Phone (802) 425-7374
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1009409 | Medicaid | VT |
Other providers in Burlington, VT
- Green Mountain Aid, Inc.
- Green Mountain Behavioral Medicine LLC
- Green Mountain Endodontics, PLLC
- Green Mountain Internal Medicine PLC
- Green Mountain Rehabilitation & Sports Medicine LLC
- Curtis Green
- Hannah E. Green
- Joshua D. Green
- Kayla Mae Green
- Caitlin Greenberg
All providers in Burlington, VT · Pediatrics Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.