Provider Demographics
NPI:1285124511
Name:GREEN, MEGAN MARGARET (DO)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARGARET
Last Name:GREEN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARGARET
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:105 N ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220
Mailing Address - Country:US
Mailing Address - Phone:631-566-5743
Mailing Address - Fax:
Practice Address - Street 1:109 W 27TH ST SUITE 5S TALKIATRY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:917-634-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3167722084P0800X
VA01022059182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0116031898OtherVIRGINIA LICENSE