Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101055625 | VA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 0101055625 | VA |
NPI | 1285600486 |
---|---|
Provider Name | Keith A Glowacki |
First Address | North Chesterfield, VA 23225-4067 |
Second Address | Richmond, VA 23294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 24/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6405061 | (05) | VA |
G15670 | (02) |