Provider Demographics
NPI:1962476283
Name:GREEN, LONNY STENZLER (MD)
Entity Type:Individual
Prefix:DR
First Name:LONNY
Middle Name:STENZLER
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-288-4084
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:12129 GRAHAM MEADOWS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-6661
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-282-2601
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2018-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101049895208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962476283Medicaid
VA1962476283Medicaid
VAVAA113164Medicare PIN