MEDICARE: GLENDA ATILANO MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	18529	AL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00426540	OTHER	AL	RAIL ROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	630813275	OTHER	AL	COMMERICAL GROUP
2	051540503	OTHER	AL	BCBS
3	0403254	OTHER	AL	UNITED HEALTHCARE
4	51028509	OTHER	AL	BCBS
5	630813275	OTHER	AL	COMMERICIAL PRV
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	630813275	OTHER	AL	WORK COMP
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	51028438	OTHER	AL	BCBS

NPI Number	:	1265410781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA ATILANO MD

Provider Business Mailing Address
First Line	:	4371 NARROW LANE RD
Second Line	:	SUITE 100
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2971
Country	:	US
Telephone Number	:	334-613-7080
Fax Number	:	334-613-7081

Provider Business Practice Location Address
First Line	:	4371 NARROW LANE RD
Second Line	:	SUITE 100
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2971
Country	:	US
Telephone Number	:	334-613-7080
Fax Number	:	334-613-7081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	05/22/2008