Healthcare Provider Details

I. General information

NPI: 1952886004
Provider Name (Legal Business Name): ALVIN GREEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3759 JAY ST NE APT 2
WASHINGTON DC
20019-1835
US

IV. Provider business mailing address

3740 HAYES ST NE APT 3
WASHINGTON DC
20019-1721
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-4703
  • Fax:
Mailing address:
  • Phone: 202-580-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: