Individual
DR. GLENN EDWARD MACNICHOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 PATRICK CT, ROCKY MOUNT, NC 27804-1743
(252) 443-0400
(252) 443-0572
Mailing address
110 PATRICK CT, ROCKY MOUNT, NC 27804-1743
(252) 443-0400
(252) 443-0572
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
34389
NC
208VP0014X
Interventional Pain Medicine Physician
Primary
34389
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7953696
—
NC
Enumeration date
04/27/2006
Last updated
05/06/2020
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