Individual
DR. GLENN BANEGURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1700 MEDICAL WAY, HOSPITALIST OFFICE, SNELLVILLE, GA 30078-2195
(617) 901-6120
Mailing address
1700 MEDICAL WAY, SNELLVILLE, GA 30078-2195
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036147581
IL
207R00000X
Internal Medicine Physician
16816
HI
207R00000X
Internal Medicine Physician
1796320
WI
207R00000X
Internal Medicine Physician
23114
NV
207R00000X
Internal Medicine Physician
25734
MS
207R00000X
Internal Medicine Physician
31509
AL
207R00000X
Internal Medicine Physician
334379
LA
207R00000X
Internal Medicine Physician
34002
SC
207R00000X
Internal Medicine Physician
Primary
35270
NH
207R00000X
Internal Medicine Physician
35C.000288
OH
207R00000X
Internal Medicine Physician
66752
GA
207R00000X
Internal Medicine Physician
67897
TN
208M00000X
Hospitalist Physician
129782
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340027
—
SC
01
—
SCB3975019
MEDICARE PIN
SC
01
—
SCB3979068
MEDICARE PIN
SC
Enumeration date
06/19/2008
Last updated
12/09/2025
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