MEDICARE: RHE'A GREEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	12074	GA
2	363AM0700X	Medical Physician Assistant	C0009899	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770166209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHE'A GREEN PA-C

Provider Business Mailing Address
First Line	:	200 HOSPITAL DR # 300
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5884
Country	:	US
Telephone Number	:	410-837-2050
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 HOSPITAL DR # 300
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5884
Country	:	US
Telephone Number	:	410-837-2050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	06/23/2026

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Directions to “ RHE'A GREEN PA-C” Practice Location

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