Provider Demographics
NPI:1427081595
Name:GLENWOOD INTERNAL MEDICINE, LLP
Entity type:Organization
Organization Name:GLENWOOD INTERNAL MEDICINE, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:814-864-4987
Mailing Address - Street 1:213 EAST 41ST ST.
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504
Mailing Address - Country:US
Mailing Address - Phone:814-864-4987
Mailing Address - Fax:814-866-1130
Practice Address - Street 1:213 EAST 41ST ST.
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504
Practice Address - Country:US
Practice Address - Phone:814-864-4987
Practice Address - Fax:814-866-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
040007OtherBCBS
040007Medicare ID - Type Unspecified