Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D0090587 | MD |
NPI | 1043674708 |
---|---|
Provider Name | Jeffrey Glicksman |
First Address | Upper Marlboro, MD 20774-5374 |
Second Address | Upper Marlboro, MD 20774-5374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2016 |
Last Update Date | 25/08/2021 |