Provider Demographics
NPI:1417082173
Name:GLOTFELTY, DANIELLE R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:R
Last Name:GLOTFELTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 WILLOWBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:240-964-5600
Mailing Address - Fax:240-964-5605
Practice Address - Street 1:12500 WILLOWBROOK ROAD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:240-964-5600
Practice Address - Fax:240-964-5605
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005263363A00000X
PAMA003356L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical