| Organization Name: | JEFFREY E. GREEN |
| NPI Number: | 1083000939 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY GREEN (PROVIDER) |
| Mailing Address: | 10600 Tanager Ln Potomac |
| State: | MD US |
| Postal Code: | 208546316 |
| Phone Number: | 3013320467 |
| Fax Number: | |
| NPI Enumeration Date: | 04/07/2015 |
| NPI Last Update Date: | 04/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | D0031283 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |