Provider Demographics
NPI:1114926557
Name:GLENN, DAVID LOCKE JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LOCKE
Last Name:GLENN
Suffix:JR
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 1:260 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3378
Mailing Address - Country:US
Mailing Address - Phone:828-883-5330
Mailing Address - Fax:828-883-5242
Practice Address - Street 1:260 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3378
Practice Address - Country:US
Practice Address - Phone:828-883-5330
Practice Address - Fax:828-883-5242
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24763208600000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2194978EMedicare PIN
C84086Medicare UPIN
NC891152JMedicaid
2194978DMedicare PIN
NC1152JOtherBCBS