Provider Demographics
NPI:1386074508
Name:LALLJIE, GLEN (MD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:
Last Name:LALLJIE
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:SUITE F204 BAYWEST CENTER
Mailing Address - Street 2:HARBOUR STREET
Mailing Address - City:MONTEGO BAY
Mailing Address - State:ST. JAMES
Mailing Address - Zip Code:00000
Mailing Address - Country:JM
Mailing Address - Phone:876-940-1106
Mailing Address - Fax:
Practice Address - Street 1:SUITE F204 BAYWEST CENTER
Practice Address - Street 2:HARBOUR STREET
Practice Address - City:MONTEGO BAY
Practice Address - State:ST. JAMES
Practice Address - Zip Code:00000
Practice Address - Country:JM
Practice Address - Phone:876-940-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86463207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease