Provider Demographics
NPI:1184654279
Name:MCGLYNN, MARIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:J
Last Name:MCGLYNN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3291 WALNUT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4412
Mailing Address - Country:US
Mailing Address - Phone:925-513-9495
Mailing Address - Fax:925-626-3782
Practice Address - Street 1:3291 WALNUT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4412
Practice Address - Country:US
Practice Address - Phone:925-513-9495
Practice Address - Fax:925-626-3782
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-05-30
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Provider Licenses
StateLicense IDTaxonomies
CAA64911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A649110Medicaid
H13558Medicare UPIN
CA080157586Medicare PIN
CA00A649110Medicaid