Individual
MARK GLASS-ROYAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 W 7TH ST, FREDERICK, MD 21701-4506
(240) 566-1720
Mailing address
PO BOX 1966, FREDERICK, MD 21702-0966
(301) 663-1277
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D39842
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300020369
RAILROAD MEDICARE
MD
Enumeration date
07/03/2006
Last updated
05/27/2009
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