Provider Demographics
NPI:1326220575
Name:GLENARD MEDICAL SERVICES, PA
Entity Type:Organization
Organization Name:GLENARD MEDICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:DODOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-590-3424
Mailing Address - Street 1:1916 CRAIN HWY S
Mailing Address - Street 2:SUITE #7
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5563
Mailing Address - Country:US
Mailing Address - Phone:410-590-3424
Mailing Address - Fax:410-590-3425
Practice Address - Street 1:1916 CRAIN HWY S
Practice Address - Street 2:SUITE #7
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5563
Practice Address - Country:US
Practice Address - Phone:410-590-3424
Practice Address - Fax:410-590-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty