Provider Demographics
NPI:1073539912
Name:WITHROW, GLENN ASHLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ASHLEY
Last Name:WITHROW
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1728 FORDHAM BLVD
Mailing Address - Street 2:151 RAMS PLAZA
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:919-968-1985
Mailing Address - Fax:919-942-0038
Practice Address - Street 1:1728 FORDHAM BLVD
Practice Address - Street 2:151 RAMS PLAZA
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2397
Practice Address - Country:US
Practice Address - Phone:919-968-1985
Practice Address - Fax:919-942-0038
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-02-13
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Provider Licenses
StateLicense IDTaxonomies
NC27884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC88667OtherNC BLUE CROSS BLUE SHIELD ID#
NC203572BOtherPTAN
NC203572BOtherPTAN