MEDICARE: DR. DANIEL GREEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	D0039385	MD

General Provider Information

NPI Number	:	1508835372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL GREEN M.D.

Provider Business Mailing Address
First Line	:	25 HOOKS LN
Second Line	:	SUITE 212
City	:	BALTIMORE
State	:	MD
Zip	:	21208-1617
Country	:	US
Telephone Number	:	410-653-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	15709 YEOHO RD
Second Line	:
City	:	SPARKS
State	:	MD
Zip	:	21152-9620
Country	:	US
Telephone Number	:	410-409-2186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	07/08/2007

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