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General NPI Number Information
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NPI Number | 1356732242
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Entity Type | Individual
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Provider Name | REBECCA ANN GLUCK PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 2700 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21218-4300
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Country | US
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Telephone | 410-554-6300
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Fax | 410-554-3919
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Provider Business Mailing Address
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Address Line | 401 N MICHIGAN AVE SUITE 1200
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City | CHICAGO
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State | IL
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Zip | 60611-4264
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Country | US
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Telephone | 312-635-0973
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Fax | 813-290-9691
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0005673
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License Number State | MD
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