Healthcare Provider Details

I. General information

NPI: 1275238172
Provider Name (Legal Business Name): NEIL WILLIAM GLENN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER RD STE 1080
COLUMBUS OH
43214-3984
US

IV. Provider business mailing address

3555 OLENTANGY RIVER RD STE 1080
COLUMBUS OH
43214-3984
US

V. Phone/Fax

Practice location:
  • Phone: 614-865-6401
  • Fax: 614-865-3259
Mailing address:
  • Phone: 614-865-6401
  • Fax: 614-865-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.018361
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: