Individual
GLENN ROSS GANGI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2835 E HWY 76, STE 3, MULLINS, SC 29574
(843) 423-0230
(843) 423-0802
Mailing address
2234 COLONIAL BLVD, MANAGED CARE DEPT, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
17068
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000206904
UNISON HEALTH PLAN
SC
01
—
0930136
CIGNA
SC
01
—
2199551A
CIGNA MEDICARE
NC
01
—
4241328
AETNA
SC
01
—
776932
WELLCARE
SC
05
—
7905534
—
NC
01
—
80023027
SELECT HEALTH
SC
05
—
G1521
—
SC
05
—
GP4522
—
SC
01
—
P00360556
RAILROAD MEDICARE
SC
05
—
T10681
—
SC
Enumeration date
03/07/2006
Last updated
12/29/2016
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