Provider Demographics
NPI:1255332094
Name:COONEY, C GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:GLENN
Last Name:COONEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2186 GEARY BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3455
Mailing Address - Country:US
Mailing Address - Phone:415-346-7200
Mailing Address - Fax:415-346-7517
Practice Address - Street 1:2186 GEARY BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3455
Practice Address - Country:US
Practice Address - Phone:415-346-7200
Practice Address - Fax:415-346-7517
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG076882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF68189Medicare UPIN