Provider Demographics
NPI:1205215894
Name:GREEN, MAYA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 STRAUSE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-5054
Mailing Address - Country:US
Mailing Address - Phone:704-398-6488
Mailing Address - Fax:
Practice Address - Street 1:9310 STRAUSE DR STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-5054
Practice Address - Country:US
Practice Address - Phone:704-398-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-02983207Q00000X
VA0101261920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine