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Organization

GREEN DOOR, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL CLANCY (DEPUTY DIRECTOR)
(202) 464-9200
Entity
Organization

Contact information

Practice address
1221 TAYLOR ST NW, WASHINGTON, DC 20011-5617
(202) 464-9200
(202) 464-5740
Mailing address
1221 TAYLOR ST NW, WASHINGTON, DC 20011-5617
(202) 464-9200
(202) 464-5740

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD33367
DC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
23653
CHARTERED HEALTH PLAN
DC
01
281810
AMERIGROUP (MEDICAID MCO)
DC
01
5181
HEALTHRIGHT (MEDICAID MCO
DC
Enumeration date
01/29/2007
Last updated
08/22/2020
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