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Individual

GLENN RIDENOUR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3100 MACCORKLE AVE SE, SUITE 604, CHARLESTON, WV 25304-1223
(304) 345-5421
(304) 345-0951
Mailing address
3100 MACCORKLE AVE SE, STE 902, CHARLESTON, WV 25304-1234
(304) 345-5421
(304) 345-0951

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
22336
WV
207RI0200X
Infectious Disease Physician
Primary
22336
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3810005579
WV
Enumeration date
05/31/2006
Last updated
05/05/2017
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