Provider Demographics
NPI:1225083108
Name:MAJOR, GLENNA (MD)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:MAJOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:270-766-1222
Practice Address - Street 1:1072 S DIXIE BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1103
Practice Address - Country:US
Practice Address - Phone:270-351-8166
Practice Address - Fax:270-351-8322
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY358342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY341183OtherTRICARE
KY000000330457OtherANTHEM
KY30605018Medicaid
11574924OtherCAQH
KY0762326Medicare ID - Type UnspecifiedMEDICARE
KY0358748Medicare ID - Type UnspecifiedMEDICARE
H40175Medicare UPIN
KY0358850Medicare ID - Type UnspecifiedMEDICARE
KY0026698Medicare ID - Type UnspecifiedMEDICARE
KY341183OtherTRICARE
KY000000330457OtherANTHEM
0359050Medicare ID - Type Unspecified
KY30605018Medicaid
KY0762229Medicare ID - Type UnspecifiedMEDICARE
KY0358649Medicare ID - Type UnspecifiedMEDICARE