Mitra Marie Green, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

020108 Issued in LA

Practice address

3421 Medical Park Dr
Monroe, LA 71203-2355

Phone

(318) 376-7337

NPI assigned

Jun 26, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1699702761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 LAMY LN",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013735",
            "telephone_number": "318-387-3453",
            "fax_number": "318-323-9045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3421 MEDICAL PARK DR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712032355",
            "telephone_number": "318-376-7337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "309 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712017407",
            "country_code": "US",
            "telephone_number": "318-966-4470",
            "fax_number": "318-966-4864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MITRA",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "020108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1950831",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia Green
• Deborah Green, NP
• Gregory Roper Green, MD
• Ke'Asia Green
• Mary Green, LCSW
• Ronkeyuna Green
• Shelitha Green
• Gary Lee Greene, LPC
• Regina D Greenwood, OT
• Greer Neurosurgery Clinic

• Pediatrics Physician in Monroe, LA
• Providers in Monroe, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.