Provider Demographics
NPI:1215936901
Name:GLENSIDE MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:GLENSIDE MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR, ENTERPRISE REVENUE CYC
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-262-4763
Mailing Address - Street 1:4000A GLENSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-4102
Mailing Address - Country:US
Mailing Address - Phone:804-262-4763
Mailing Address - Fax:804-264-9683
Practice Address - Street 1:4000A GLENSIDE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-4102
Practice Address - Country:US
Practice Address - Phone:804-262-4763
Practice Address - Fax:804-264-9683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08004Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER