Provider Demographics
NPI:1124027727
Name:GLICKMAN, JOEL D (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:1ST FLOOR, SUITE 300 S
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4306
Mailing Address - Country:US
Mailing Address - Phone:215-662-2638
Mailing Address - Fax:215-349-5703
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:1ST FLOOR, SUITE 300 S
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-662-2638
Practice Address - Fax:215-349-5703
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA044118L207RN0300X
PAMD044118L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
670719OtherBLUE CROSS/BLUE SHIELD
PA0000125516705Medicaid
E36488Medicare UPIN
PA670719Medicare PIN