Individual
MR. GLENN MARTIN SANNICOLAS II
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
HEALTH SERVICES TECH
Contact information
Practice address
COMDT (CG-1122), 2100 2ND ST SW, SUITE 5314, WASHINGTON, DC 20593-0001
(252) 335-6521
(252) 335-6255
Mailing address
COMDT (CG-1122), 2100 2ND ST SW, SUITE 5314, WASHINGTON, DC 20593-0001
(252) 335-6521
(252) 335-6255
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
12/23/2005
Last updated
07/08/2007
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