Provider Demographics
NPI:1114981651
Name:GLICK, DENNIS RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RICHARD
Last Name:GLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 DERBY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2651
Mailing Address - Country:US
Mailing Address - Phone:707-396-3270
Mailing Address - Fax:
Practice Address - Street 1:7474 GREENWAY CENTER DR
Practice Address - Street 2:#730
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3504
Practice Address - Country:US
Practice Address - Phone:301-982-3437
Practice Address - Fax:301-982-9452
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD733812084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49907Medicare UPIN
CA00G451410Medicare ID - Type Unspecified