Provider Demographics
NPI:1538377213
Name:GLENN, GREGORY MARK (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARK
Last Name:GLENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:14525 MONTEVIDEO RD
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-8858
Mailing Address - Country:US
Mailing Address - Phone:301-216-0742
Mailing Address - Fax:
Practice Address - Street 1:14525 MONTEVIDEO RD
Practice Address - Street 2:
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-8858
Practice Address - Country:US
Practice Address - Phone:240-899-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM367002080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine