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General NPI Number Information
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NPI Number | 1619298460
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Entity Type | Individual
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Provider Name | LISA JEANNETTE GREEN MD
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Gender | Female
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 6400 BROOKTREE CT STE 100&120
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City | WEXFORD
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State | PA
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Zip | 15090-9271
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Country | US
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Telephone | 412-785-1057
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Fax |
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Provider Business Mailing Address
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Address Line | 9600 BLACKWELL RD STE 500
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City | ROCKVILLE
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State | MD
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Zip | 20850-3783
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Country | US
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Telephone | 412-785-1057
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 51441
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD489524
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 51441
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | MD489524
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License Number State | PA
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