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General NPI Number Information
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NPI Number | 1568423051
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Entity Type | Organization
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Legal Business Name | JOHN L GLENN MD
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Dates
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Enumeration Date | 04/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 84 EAST STATE ST
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City | GLOVERSVILLE
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State | NY
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Zip | 12078
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Country | US
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Telephone | 518-773-8894
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Fax | 518-773-8125
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Provider Business Mailing Address
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Address Line | 84 EAST STATE ST PO BOX 1279
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City | GLOVERSVILLE
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State | NY
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Zip | 12078
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Country | US
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Telephone | 518-773-8894
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Fax | 518-773-8125
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Authorized Official
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Title or Position | MEDICAL MD OWNER
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Name | MR. JOHN LESTER GLENN
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Credential | MD
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Telephone | 518-773-8894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 1575271
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License Number State | NY
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