Provider Demographics
NPI:1902226806
Name:GREENE, DAVID ELLWOOD (MED TECH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ELLWOOD
Last Name:GREENE
Suffix:
Gender:M
Credentials:MED TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8607 2ND AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3355
Mailing Address - Country:US
Mailing Address - Phone:301-495-6330
Mailing Address - Fax:301-495-6332
Practice Address - Street 1:8607 2ND AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3355
Practice Address - Country:US
Practice Address - Phone:301-495-6330
Practice Address - Fax:301-495-6332
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2091251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health