Healthcare Provider Details

I. General information

NPI: 1053772418
Provider Name (Legal Business Name): MARGARET GLENNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

IV. Provider business mailing address

1848 DORSET DR
ROANOKE VA
24018-2718
US

V. Phone/Fax

Practice location:
  • Phone: 540-525-1818
  • Fax:
Mailing address:
  • Phone: 540-525-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: