Provider Demographics
NPI:1528165974
Name:GREEN, REGINALD SCOTT
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:SCOTT
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 CYNTHIA LN
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1301
Mailing Address - Country:US
Mailing Address - Phone:240-361-1874
Mailing Address - Fax:
Practice Address - Street 1:19735 GERMANTOWN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1214
Practice Address - Country:US
Practice Address - Phone:240-454-6790
Practice Address - Fax:301-528-8092
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD182832251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic