MEDICARE: DR. JANE GLENCHUR 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	207N00000X	Dermatology Physician	35.056873	OH
2	207ND0900X	Dermatopathology Physician	35.056873	OH

General Provider Information

NPI Number	:	1609216993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE GLENCHUR M.D.

Provider Business Mailing Address
First Line	:	6547 BUTTERFLY WAY
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1357
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6547 BUTTERFLY WAY
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1357
Country	:	US
Telephone Number	:	513-739-5300
Fax Number	:

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

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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