Provider Demographics
NPI:1720254261
Name:GREEN, SHANNON BECKER (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:BECKER
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:FLYNN
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5215 LOUGHORO ROAD NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2633
Mailing Address - Country:US
Mailing Address - Phone:202-243-3500
Mailing Address - Fax:202-966-8441
Practice Address - Street 1:5215 LOUGHORO ROAD NW
Practice Address - Street 2:SUITE 500
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2633
Practice Address - Country:US
Practice Address - Phone:202-243-3500
Practice Address - Fax:202-966-8441
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019405207V00000X
DCMD039383207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology