MEDICARE: DR. GLENN DOUGLAS SANDBERG M.D.

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	207ZN0500X	Neuropathology Physician	G65358	CA

General Provider Information

NPI Number	:	1245329739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN DOUGLAS SANDBERG M.D.

Provider Business Mailing Address
First Line	:	1123 CHERRY POINT RD
Second Line	:
City	:	WEST RIVER
State	:	MD
Zip	:	20778-9780
Country	:	US
Telephone Number	:	202-782-2804
Fax Number	:

Provider Business Practice Location Address
First Line	:	ARMED FORCES INSTITUTE OF PATHOLOGY
Second Line	:	14TH AND ALASKA
City	:	WASHINGTON
State	:	DC
Zip	:	20306-0001
Country	:	US
Telephone Number	:	202-782-2804
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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