Provider Demographics
NPI:1083479521
Name:GREEN, DONALD RICARDO JR
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RICARDO
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 M ST SE STE 674
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3519
Mailing Address - Country:US
Mailing Address - Phone:240-432-5234
Mailing Address - Fax:
Practice Address - Street 1:100 M ST SE STE 674
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3519
Practice Address - Country:US
Practice Address - Phone:240-432-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3002490726251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage