Provider Demographics
NPI:1073518155
Name:GLANCY, JOHN ELLIS III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELLIS
Last Name:GLANCY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 BRIGGS CHANEY ROAD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5529
Mailing Address - Country:US
Mailing Address - Phone:301-236-0505
Mailing Address - Fax:
Practice Address - Street 1:1731 BRIGGS CHANEY ROAD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-5529
Practice Address - Country:US
Practice Address - Phone:301-236-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025345208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD373631800Medicaid
DC0696OtherBLUECROSS/BLUE SHIELD DC
D09407Medicare UPIN
DC0696OtherBLUECROSS/BLUE SHIELD DC