Provider Demographics
NPI:1144233289
Name:LAWRENCE J GREEN, MD LLC
Entity Type:Organization
Organization Name:LAWRENCE J GREEN, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-610-0663
Mailing Address - Street 1:15005 SHADY GROVE RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6340
Mailing Address - Country:US
Mailing Address - Phone:301-610-0663
Mailing Address - Fax:301-610-5420
Practice Address - Street 1:15005 SHADY GROVE RD
Practice Address - Street 2:SUIE 440
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6340
Practice Address - Country:US
Practice Address - Phone:301-610-0663
Practice Address - Fax:301-610-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50346207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5802523OtherAETNA
MD258278OtherMAMSI/OPTIMUM CHOICE
MD4281-0001OtherBCBS
MD5802523OtherAETNA
MD4281-0001OtherBCBS