Healthcare Provider Details

I. General information

NPI: 1962476283
Provider Name (Legal Business Name): LONNY STENZLER GREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12129 GRAHAM MEADOWS DR
RICHMOND VA
23233-6661
US

IV. Provider business mailing address

7130 GLEN FOREST DR SUITE 101
RICHMOND VA
23226-3754
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-4084
  • Fax: 804-282-2601
Mailing address:
  • Phone: 804-288-4084
  • Fax: 804-282-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101049895
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: