Healthcare Provider Details

I. General information

NPI: 1639164858
Provider Name (Legal Business Name): TROY M GLEMBOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 AMHERST ST STE F
WINCHESTER VA
22601-2841
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 100
WINCHESTER VA
22601-2896
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-0010
  • Fax: 540-536-0061
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30165
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101049552
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: