Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | D0031283 | MD |
N | 208000000X | Pediatrician | D0031283 | MD |
NPI | 1497246649 |
---|---|
Provider Name | Jeffrey Emanuel Green |
First Address | Potomac, MD 20854-6316 |
Second Address | Potomac, MD 20854-6316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2018 |
Last Update Date | 23/05/2018 |