Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 0104000858 | VA |
N | 111NN0400X | Neurology | 38MC00446700 | NJ |
N | 111NN0400X | Neurology | F--0000526 | DE |
NPI | 1073651725 |
---|---|
Provider Name | Dr. David Mark Glick |
First Address | Chesterfield, VA 23832-9115 |
Second Address | Richmond, VA 23225-4953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |