Basic Information
| Provider Information | |||||||||
| NPI: | 1669613345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | TANYA | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 OLD CHAIN BRIDGE RD STE 185 | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221013945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039428110 | ||||||||
| FaxNumber: | 7039428042 | ||||||||
| Practice Location | |||||||||
| Address1: | 133 ROLLINS AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014687670 | ||||||||
| FaxNumber: | 3014687620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2009 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 00745 | MD | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | 00745 | MD | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.