Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101245263 | VA |
N | 207Q00000X | Family Doctor | 200101205 | NC |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 0101245263 | VA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 200101205 | NC |
NPI | 1750351557 |
---|---|
Provider Name | Glenn D Golaszewski |
First Address | Mount Airy, NC 27030-6692 |
Second Address | Mount Airy, NC 27030-6692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 13/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1297N | BCBS OF NC (01) | NC |
891297N | (05) | NC |
H23117 | (02) |