Provider Demographics
NPI:1275193807
Name:GLENN, RACHEL LAVERNE (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAVERNE
Last Name:GLENN
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:ORTHOPAEDIC SURGERY
Mailing Address - Street 2:2 MEDICAL PARK, STE 105
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6812
Mailing Address - Fax:803-434-7306
Practice Address - Street 1:ORTHOPAEDIC SURGERY
Practice Address - Street 2:2 MEDICAL PARK, STE 105
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6812
Practice Address - Fax:803-434-7306
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL82823207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery