Provider Demographics
NPI:1992138051
Name:ALEWINE, J. GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:GLENN
Last Name:ALEWINE
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 1:4460 BROAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4012
Mailing Address - Country:US
Mailing Address - Phone:803-896-2181
Mailing Address - Fax:803-896-2934
Practice Address - Street 1:4460 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4012
Practice Address - Country:US
Practice Address - Phone:803-896-2181
Practice Address - Fax:803-896-2934
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine