Provider Demographics
NPI:1073628863
Name:GREEN, ELAINE REEVES (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:REEVES
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 S UTAH ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1908
Mailing Address - Country:US
Mailing Address - Phone:703-820-2261
Mailing Address - Fax:
Practice Address - Street 1:14150 PARKEAST CIR STE 200
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2295
Practice Address - Country:US
Practice Address - Phone:703-968-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010300272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry