Individual
GLEN A. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-7456
(757) 668-9255
Mailing address
PO BOX 79137, BALTIMORE, MD 21279-0137
(757) 668-7200
(757) 668-9691
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0101039300
VA
208000000X
Pediatrics Physician
0101039300
VA
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
0101039300
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000931601
—
DE
05
—
0018694320001
—
PA
05
—
006722164
—
VA
05
—
119981100
—
MD
05
—
1802339000
—
WV
05
—
890677B
—
NC
Enumeration date
05/16/2006
Last updated
12/09/2009
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