Mandeville, Glenn A

Mandeville, Glenn A is an individual health care provider with primary practice located at 1429 N 6Th St , Terre Haute IN 47807-1037. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Mandeville, Glenn A can be contacted via phone (812) 242-3110.

Contact Information

Primary practice address
1429 N 6Th St Terre Haute IN 47807-1037
Phone: (812) 242-3110
Fax: (812) 242-3795
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 01041222A Indiana

Profile Details

NPI number 1942318795
LBN Legal business name Mandeville, Glenn A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 29th, 2006
Last updated Mar 14th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942318795 NPPES
Other 020024441 RAILROAD MCARE PALAMETTO
MEDICAID 100337060 RAILROAD MCARE PALAMETTO
Other P00834915 RAILROAD MCARE PALAMETTO
Other 000000089623 RAILROAD MCARE PALAMETTO

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