Healthcare Provider Details

I. General information

NPI: 1073518155
Provider Name (Legal Business Name): JOHN ELLIS GLANCY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 BRIGGS CHANEY ROAD
SILVER SPRING MD
20905-5529
US

IV. Provider business mailing address

1731 BRIGGS CHANEY ROAD
SILVER SPRING MD
20905-5529
US

V. Phone/Fax

Practice location:
  • Phone: 301-236-0505
  • Fax:
Mailing address:
  • Phone: 301-236-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0025345
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: