Provider Demographics
NPI:1154431914
Name:GREEN, JODY ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:ELLEN
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5505 DURBIN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1011
Mailing Address - Country:US
Mailing Address - Phone:301-986-0826
Mailing Address - Fax:301-986-0351
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:#2500
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-530-9200
Practice Address - Fax:301-530-9442
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00524442084N0400X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine