Provider Demographics
NPI:1043197577
Name:GREEN, BRUCE H IV
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:GREEN
Suffix:IV
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 1:700 7TH ST SW APT 114
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2461
Mailing Address - Country:US
Mailing Address - Phone:202-344-0049
Mailing Address - Fax:
Practice Address - Street 1:905 6TH ST SW APT 611
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3820
Practice Address - Country:US
Practice Address - Phone:771-245-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant