Organization
JOHN L GLENN MD
Active
Other names
Mountain Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN LESTER GLENN MD (MEDICAL MD OWNER)
(518) 773-8894
Entity
Organization
Contact information
Practice address
84 EAST STATE ST, GLOVERSVILLE, NY 12078
(518) 773-8894
(518) 773-8125
Mailing address
84 EAST STATE ST, PO BOX 1279, GLOVERSVILLE, NY 12078
(518) 773-8894
(518) 773-8125
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
1575271
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00890859
—
NY
Enumeration date
04/01/2006
Last updated
08/22/2020
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