Provider Demographics
NPI:1922207075
Name:POTOMAC ARTHRITIS & RHEUMATISM MADALENE K. GREENE, MD, P.C.
Entity Type:Organization
Organization Name:POTOMAC ARTHRITIS & RHEUMATISM MADALENE K. GREENE, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADALENE
Authorized Official - Middle Name:KOMISAR
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-530-9490
Mailing Address - Street 1:10401 OLD GEORGETOWN RD
Mailing Address - Street 2:SUITE #305
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1911
Mailing Address - Country:US
Mailing Address - Phone:301-530-9490
Mailing Address - Fax:301-530-9493
Practice Address - Street 1:10401 OLD GEORGETOWN RD
Practice Address - Street 2:SUITE #305
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1911
Practice Address - Country:US
Practice Address - Phone:301-530-9490
Practice Address - Fax:301-530-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38031207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02693Medicare PIN