Provider Demographics
NPI:1922203785
Name:GREEN, MAYER (DC)
Entity Type:Individual
Prefix:DR
First Name:MAYER
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11006 VEIRS MILL RD
Mailing Address - Street 2:#L15-282
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2582
Mailing Address - Country:US
Mailing Address - Phone:301-933-7827
Mailing Address - Fax:240-290-0342
Practice Address - Street 1:11301 AMHERST AVE
Practice Address - Street 2:STE 102
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4665
Practice Address - Country:US
Practice Address - Phone:301-933-7827
Practice Address - Fax:240-290-0342
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD149652Medicare PIN