Provider Demographics
NPI:1104897560
Name:GLICKMAN, MARC H (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:H
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:397 LITTLE NECK RD
Mailing Address - Street 2:STE 100 3300 SOUTH BLDG
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-470-5570
Mailing Address - Fax:757-227-3377
Practice Address - Street 1:397 LITTLE NECK RD
Practice Address - Street 2:STE 100 3300 SOUTH BLDG
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-470-5570
Practice Address - Fax:757-227-3377
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B10256Medicare UPIN