Provider Demographics
NPI:1417981614
Name:MEREWITZ, GLENN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:MEREWITZ
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:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4000
Practice Address - Fax:215-807-8235
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021953E207P00000X
NJ25MA04322900207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009543230010Medicaid
PA00954323-03OtherAMERICHOICE BUCKS
NJ0404821000OtherAMERIHEALTH
PA0009543230003Medicaid
PA00954323-04OtherAMERICHOICE FRANKFORD
PA30021588OtherKEYSTONE MERCY
PA0009543230004Medicaid
PA1437686OtherPERSONAL CHOICE
NJ30048919OtherKEYSTONE MERCY
NJ5142504Medicaid
PA0054318000OtherKEYSTONE IBC
PA07645OtherHEALTH PARTNERS
PA1437686OtherHIGHMARK BLUE SHIELD
NJ60018877OtherHORIZON NJ HEALTH
PA7970674OtherCIGNA
PA00954323-02OtherAMERICHOICE TORRESDALE
PA20045153OtherAMERIHEALTH MERCY
PA452729OtherAETNA CONTRACT
NJP00338388Medicare PIN
PA00954323-02OtherAMERICHOICE TORRESDALE
PA00954323-03OtherAMERICHOICE BUCKS
PA07645OtherHEALTH PARTNERS