Healthcare Provider Details

I. General information

NPI: 1770166209
Provider Name (Legal Business Name): RHE'A GREEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL DR # 300
GLEN BURNIE MD
21061-5884
US

IV. Provider business mailing address

200 HOSPITAL DR # 300
GLEN BURNIE MD
21061-5884
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-2050
  • Fax:
Mailing address:
  • Phone: 410-837-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12074
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0009899
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: