Provider Demographics
NPI:1073296596
Name:GREEN, CLAIRE ALTHEA
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:ALTHEA
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13206 CHOPIN CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7144
Mailing Address - Country:US
Mailing Address - Phone:240-463-6693
Mailing Address - Fax:
Practice Address - Street 1:6100 DAYLONG LN STE 103
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1631
Practice Address - Country:US
Practice Address - Phone:410-531-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program