MEDICARE: MRS. JESSICA B GLANZ PA-C

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
1	363A00000X	Physician Assistant	MA055651	PA
2	363A00000X	Physician Assistant	C02458	MD

General Provider Information

NPI Number	:	1790746972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA B GLANZ PA-C

Provider Business Mailing Address
First Line	:	2012 S TOLLGATE RD
Second Line	:	SUITE 200
City	:	BEL AIR
State	:	MD
Zip	:	21015-5900
Country	:	US
Telephone Number	:	410-569-5151
Fax Number	:	410-569-1131

Provider Business Practice Location Address
First Line	:	2012 S TOLLGATE RD
Second Line	:	SUITE 200
City	:	BEL AIR
State	:	MD
Zip	:	21015-5900
Country	:	US
Telephone Number	:	410-569-5151
Fax Number	:	410-569-1131

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	10/15/2016

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