Healthcare Provider Details

I. General information

NPI: 1487684924
Provider Name (Legal Business Name): ANDREW H GLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAD RIVER HEALTHCARE 3798 JANES ROAD STE 6
ARCATA CA
95521-4742
US

IV. Provider business mailing address

3798 JANES ROAD STE 6
ARCATA CA
95521-4742
US

V. Phone/Fax

Practice location:
  • Phone: 650-552-8100
  • Fax: 707-825-4978
Mailing address:
  • Phone: 707-825-4971
  • Fax: 707-825-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG87831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: