Provider Demographics
NPI:1437153483
Name:RAYMOND, GLENN ALLIN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ALLIN
Last Name:RAYMOND
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 1:360 S HERLONG AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1160
Mailing Address - Country:US
Mailing Address - Phone:803-366-4171
Mailing Address - Fax:803-366-6890
Practice Address - Street 1:360 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1160
Practice Address - Country:US
Practice Address - Phone:803-366-4171
Practice Address - Fax:803-366-6890
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21510207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT56016Medicaid
G52126Medicare UPIN