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General NPI Number Information
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NPI Number | 1194724476
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Entity Type | Individual
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Provider Name | TAMARA MARIE GREEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | GW MEDICAL FACULTY ASSOCIATES 2120 L STREET NW, STE450
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City | WASHINGTON
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State | DC
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Zip | 20037
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Country | US
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Telephone | 202-741-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MA075650300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101241273
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License Number State | VA
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