Healthcare Provider Details

I. General information

NPI: 1649944877
Provider Name (Legal Business Name): ELIZABETH G GLOWACKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WISCONSIN AVE NW APT 702
WASHINGTON DC
20007-2413
US

IV. Provider business mailing address

2101 WISCONSIN AVE NW APT 702
WASHINGTON DC
20007-2413
US

V. Phone/Fax

Practice location:
  • Phone: 301-758-2403
  • Fax:
Mailing address:
  • Phone: 301-758-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT229571
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: