Individual
GLENN BRIAN MIZRACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4000A GLENSIDE DR, HENRICO, VA 23228-4102
(804) 262-4763
Mailing address
4000A GLENSIDE DR, HENRICO, VA 23228-4102
(804) 262-4763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101036863
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080178443
RAILROAD MEDICARE
—
01
—
141007
ANTHEM BCBS
VA
Enumeration date
07/15/2005
Last updated
12/11/2025
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