Healthcare Provider Details

I. General information

NPI: 1154324416
Provider Name (Legal Business Name): GLENN R. MEININGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 FRANKLIN SQUARE DR STE 209
BALTIMORE MD
21237-3930
US

IV. Provider business mailing address

1838 GREENE TREE RD STE 150LL
BALTIMORE MD
21208-6391
US

V. Phone/Fax

Practice location:
  • Phone: 410-602-9262
  • Fax: 410-602-9276
Mailing address:
  • Phone: 410-602-9262
  • Fax: 410-602-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0056477
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberD0056477
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: