Healthcare Provider Details

I. General information

NPI: 1952523474
Provider Name (Legal Business Name): BRIAN PHILIP GREEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE DERMATOLOGY CLINIC, AMERICA BUILDING
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8901 WISCONSIN AVE DERMATOLOGY CLINIC, AMERICA BUILDING
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-2398
  • Fax:
Mailing address:
  • Phone: 301-319-2398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberH0075064
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberOS014763
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: