=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215051719
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR NEUROLOGY & PAIN MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6420 ROCKLEDGE DR SUITE 2500
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-7837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-530-9200
-----------------------------------------------------
Fax | 301-530-9442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6420 ROCKLEDGE DR SUITE 2500
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-7837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-530-9200
-----------------------------------------------------
Fax | 301-530-9442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JODY ELLEN GREEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 301-530-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | D0052444
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | D0052444
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------