| Doctor Name: | MR. JOHN L GLENN |
| NPI Number: | 1821056433 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 1575271 |
| Business Practice Address: | 84 E. State St St. Mary's Hospital, Gloversville Fam Hlth Cntr Gloversville, NY - 12078 |
| Business Phone Number: | 5187738894 |
| Business Fax Number: | 5187738125 |
| Mailing Address: | 427 Guy Park Ave - Primary & Specialty Care Dept., St. Mary's Hospital At Amsterdam AMSTERDAM |
| State: | NY |
| Postal Code: | 12010 |
| Phone Number: | 5188417430 |
| Fax Number: | 5188417121 |
| NPI Enumeration Date: | 05/03/2006 |
| NPI Last Update Date: | 09/02/2010 |
| 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: | |