Provider Demographics
NPI:1437166402
Name:MEADOWS, GLENN I (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:I
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3036
Mailing Address - Street 2:400 RANDOLPH PLACE EAST
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-0036
Mailing Address - Country:US
Mailing Address - Phone:434-420-8112
Mailing Address - Fax:
Practice Address - Street 1:2832 CANDLERS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2287
Practice Address - Country:US
Practice Address - Phone:434-420-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080001731Medicare ID - Type Unspecified
B04969Medicare UPIN