Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 0101025726 | VA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101025726 | VA |
NPI | 1396850210 |
---|---|
Provider Name | Mr. Glenn Ray Carwell JR. |
First Address | Virginia Beach, VA 23454-2274 |
Second Address | Virginia Beach, VA 23454-2274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 07/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
261400 | ANTHEM (01) | VA |
7905293 | (05) | NC |
B07345 | (02) |