Individual
JOEL D GLICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 CIVIC CENTER BLVD, 1ST FLOOR, SUITE 300 S, PHILADELPHIA, PA 19104-4306
(215) 662-2638
(215) 349-5703
Mailing address
3400 CIVIC CENTER BLVD, 1ST FLOOR, SUITE 300 S, PHILADELPHIA, PA 19104-4306
(215) 662-2638
(215) 349-5703
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
044118L
PA
207RN0300X
Nephrology Physician
Primary
MD044118L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000125516705
—
PA
01
—
670719
BLUE CROSS/BLUE SHIELD
—
Enumeration date
07/18/2005
Last updated
09/02/2015
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