Healthcare Provider Details

I. General information

NPI: 1134501760
Provider Name (Legal Business Name): JOHN GREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD N
BETHESDA MD
20814
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2019-0528
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101286914
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: