Healthcare Provider Details

I. General information

NPI: 1104287879
Provider Name (Legal Business Name): MEGAN NOEL GREEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22780 THREE NOTCH ROAD
LEXINGTON PARK MD
20653-1538
US

IV. Provider business mailing address

22780 THREE NOTCH RD
LEXINGTON PARK MD
20653-1538
US

V. Phone/Fax

Practice location:
  • Phone: 301-737-0662
  • Fax: 301-737-0675
Mailing address:
  • Phone: 301-737-0662
  • Fax: 301-737-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS03870
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: