Healthcare Provider Details

I. General information

NPI: 1184652000
Provider Name (Legal Business Name): WENDY R GREENE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD PHYSICIAN BILLING
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

3300 GALLOWS RD PHYSICIAN BILLING
FALLS CHURCH VA
22042-3307
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-2545
  • Fax: 703-776-2917
Mailing address:
  • Phone: 703-776-2545
  • Fax: 703-776-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101059221
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: