Provider Demographics
NPI:1386796613
Name:ROSEN, GLENN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:DAVID
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:632 TERESI LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-4161
Mailing Address - Country:US
Mailing Address - Phone:650-941-9513
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:STANFORD UNIVERSITY MEDICAL CENTER
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-725-9536
Practice Address - Fax:650-725-4071
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG57077207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF02523Medicare UPIN