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General NPI Number Information
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NPI Number | 1538377213
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Entity Type | Individual
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Provider Name | GREGORY MARK GLENN MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 14525 MONTEVIDEO RD
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City | POOLESVILLE
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State | MD
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Zip | 20837-8858
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Country | US
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Telephone | 240-899-5566
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Fax |
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Provider Business Mailing Address
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Address Line | 14525 MONTEVIDEO RD
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City | POOLESVILLE
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State | MD
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Zip | 20837-8858
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Country | US
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Telephone | 301-216-0742
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Fax |
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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 | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number | M36700
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License Number State | MD
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