Individual
DR. FRED J MCGLYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 MAPLE AVE, NW MOB SUITE 200, RICHMOND, VA 23226-2553
(804) 285-2300
(804) 285-8420
Mailing address
PO BOX 71690, RICHMOND, VA 23255-1690
(804) 285-2300
(804) 285-8420
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101032933
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006494404
—
VA
01
—
200007793
GEORGIA RR MEDICARE
—
01
—
227696
ANTHEM
VA
Enumeration date
05/17/2006
Last updated
01/23/2012
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