Provider Demographics
NPI:1689013724
Name:GLENDON, DOUGLAS (HIS 28)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:GLENDON
Suffix:
Gender:M
Credentials:HIS 28
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2815
Mailing Address - Country:US
Mailing Address - Phone:978-664-2374
Mailing Address - Fax:
Practice Address - Street 1:15 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2815
Practice Address - Country:US
Practice Address - Phone:978-664-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS41684644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist