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NPI Code Detail

MEDICARE: DR. GLENN ASHLEY WITHROW M.D.

MEDICARE: DR. GLENN ASHLEY WITHROW M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician27884NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
188667OTHERNCNC BLUE CROSS BLUE SHIELD ID#
2203572BOTHERNCPTAN

General Provider Information

NPI Number : 1073539912
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLENN ASHLEY WITHROW M.D.
Provider Business Mailing Address
First Line : 1728 FORDHAM BLVD
Second Line : 151 RAMS PLAZA
City : CHAPEL HILL
State : NC
Zip : 27514
Country : US
Telephone Number : 919-968-1985
Fax Number : 919-942-0038
Provider Business Practice Location Address
First Line : 1728 FORDHAM BLVD
Second Line : 151 RAMS PLAZA
City : CHAPEL HILL
State : NC
Zip : 27514-2397
Country : US
Telephone Number : 919-968-1985
Fax Number : 919-942-0038
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 02/13/2013

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Practice Location Address:
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