Healthcare Provider Details

I. General information

NPI: 1891865325
Provider Name (Legal Business Name): GEORGE PATRICK GLICK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 ALBERT RD FL 2
BRANDYWINE MD
20613-3035
US

IV. Provider business mailing address

2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-888-2233
  • Fax: 301-888-9133
Mailing address:
  • Phone: 301-816-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR067284
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: