Provider Demographics
NPI:1275556250
Name:GETTINGER, GLEN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:SCOTT
Last Name:GETTINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 W ARLINGTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3770
Mailing Address - Country:US
Mailing Address - Phone:252-752-2140
Mailing Address - Fax:252-689-6502
Practice Address - Street 1:2080 W ARLINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3770
Practice Address - Country:US
Practice Address - Phone:252-752-2140
Practice Address - Fax:252-689-6502
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000-26823207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8935124Medicaid
NC8935124Medicaid
NCC84024Medicare UPIN