Provider Demographics
NPI:1366489619
Name:E DENNIS GLAFKIDES MD A MED CORP
Entity Type:Organization
Organization Name:E DENNIS GLAFKIDES MD A MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAFKIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-846-3281
Mailing Address - Street 1:1789 BARCELONA ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550
Mailing Address - Country:US
Mailing Address - Phone:925-371-2388
Mailing Address - Fax:925-371-2869
Practice Address - Street 1:1447 CEDARWOOD LANE
Practice Address - Street 2:STE A
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566
Practice Address - Country:US
Practice Address - Phone:925-846-3281
Practice Address - Fax:925-846-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A21858Medicare UPIN
00A197390Medicare ID - Type Unspecified