Provider Demographics
NPI:1386675601
Name:GREENWOOD, LAURENCE JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:JOSEPH
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 MIDSUMMER DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5221
Mailing Address - Country:US
Mailing Address - Phone:301-335-3854
Mailing Address - Fax:301-990-1900
Practice Address - Street 1:4200 FORBES BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4872
Practice Address - Country:US
Practice Address - Phone:301-335-3854
Practice Address - Fax:301-990-1900
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030248103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403234900Medicaid