Individual
GLEN LOY PORTWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 E WT HARRIS BLVD STE 3111, CHARLOTTE, NC 28262-7002
(704) 547-8818
(704) 547-9865
Mailing address
11301 CARMEL COMMONS BLVD, STE 302, CHARLOTTE, NC 28226-5305
(704) 372-7974
(704) 372-5166
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
9300570
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5901259
—
NC
Enumeration date
07/17/2006
Last updated
05/04/2017
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