Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mary Etosha Green, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1154827350

Mary Etosha Green, MD is a Pathology in Manchester, Connecticut. Qualified in 2018, 8 years ago. Practices with Eastern Connecticut Pathology Consultants, PC, a 19-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Connecticut.

Years since qualifying
8
Licensed in
CT
In the registry since
2018
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

Student / training record This NPI belongs to someone enrolled in a health care training programme. It carries no licence and no practice of its own, so no address or phone number is published for it.

Manchester, CT
Fax: (866) 623-8110

Additional practice locations (3)

  • 31 Union St, Vernon, CT 06066-3126 — (860) 646-1222
  • 64 Robbins St, Waterbury, CT 06708-2613 — (860) 646-1222
  • One Medical Center Blvd Winston Salem, Winston Salem, NC 27157-0001 — (337) 716-9954

Specialties & licences

Anatomic Pathology & Clinical Pathology Physician (primary) Taxonomy 207ZP0102X · Licence 74633 (CT)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1154827350
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 5, 2018
Last updated in NPPESAugust 14, 2023
Certification dateAugust 14, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPATHOLOGY
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Eastern Connecticut Pathology Consultants, Pc — 19 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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