MEDICARE: JOEL D GLICKMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	044118L	PA
2	207RN0300X	Nephrology Physician	MD044118L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	670719	OTHER		BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124027727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL D GLICKMAN MD

Provider Business Mailing Address
First Line	:	3400 CIVIC CENTER BLVD
Second Line	:	1ST FLOOR, SUITE 300 S
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4306
Country	:	US
Telephone Number	:	215-662-2638
Fax Number	:	215-349-5703

Provider Business Practice Location Address
First Line	:	3400 CIVIC CENTER BLVD
Second Line	:	1ST FLOOR, SUITE 300 S
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4306
Country	:	US
Telephone Number	:	215-662-2638
Fax Number	:	215-349-5703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	09/02/2015

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Directions to “ JOEL D GLICKMAN MD” Practice Location

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