Individual
MARTHA E GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6215 HUMPHREYS BLVD, SUITE 100, MEMPHIS, TN 38120
(901) 227-9650
Mailing address
PO BOX 1000, DEPT 34 WOMENS DIAGNOSTIC GROUP PLLC, MEMPHIS, TN 38120
(901) 383-8860
(901) 383-8985
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
30861
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05720002
—
MS
05
—
149402001
—
AR
01
—
300138547
MEDICARE RR
TN
05
—
3838028
—
TN
01
—
4053347
BCBS
TN
01
—
98185
BCBS
AR
Enumeration date
08/22/2006
Last updated
07/24/2007
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