| Organization Name: | JOHN L GLENN MD |
| NPI Number: | 1568423051 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN LESTER GLENN (MEDICAL MD OWNER) |
| Mailing Address: | 84 East State St Gloversville |
| State: | NY US |
| Postal Code: | 12078 |
| Phone Number: | 5187738894 |
| Fax Number: | 5187738125 |
| NPI Enumeration Date: | 04/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 1575271 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |