Provider Demographics
NPI:1356471007
Name:FEOLE, GLENN LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:LOUIS
Last Name:FEOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3825
Mailing Address - Country:US
Mailing Address - Phone:919-833-3111
Mailing Address - Fax:919-834-3118
Practice Address - Street 1:1011 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3825
Practice Address - Country:US
Practice Address - Phone:919-833-3111
Practice Address - Fax:919-834-3118
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002- 01244208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFF5198076OtherDEA LICENSE
NCNCQ720BMedicare PIN
NCNCQ720CMedicare PIN
NCNCQ720DMedicare PIN
NC2002- 01244OtherNORTH CAROLINA MEDICAL BOARD LICENSE
NCNCQ720EMedicare PIN
NCFF5198076OtherDEA LICENSE