Provider Demographics
NPI:1194875229
Name:GLENN, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:GLENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6537
Mailing Address - Country:US
Mailing Address - Phone:650-787-4765
Mailing Address - Fax:
Practice Address - Street 1:316 S ELDORADO ST STE 110
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3330
Practice Address - Country:US
Practice Address - Phone:650-477-2993
Practice Address - Fax:650-340-9514
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83704207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA222799 (EMP MARIN)Medicare PIN
CACA222761 (SAS WC)Medicare PIN
CACA222801 (EMP SOLANOMedicare PIN
CACA222802 (EMP AL)Medicare PIN
CACA222800 (EMP SF)Medicare PIN
CACA177387Medicare PIN
CACA222760 (SAS NAPA)Medicare PIN
CACA222798 (EMP CC)Medicare PIN