Provider Demographics
NPI:1447241989
Name:ANDERSEN, GLENNA R (MD)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:R
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:8501 ARLINGTON BLVD
Practice Address - Street 2:STE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4617
Practice Address - Country:US
Practice Address - Phone:703-560-1612
Practice Address - Fax:703-573-0217
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101038435207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
540894297OtherPHCS
0919870001OtherCIGNA
240947OtherMDIPA/OPTIMUM
468150OtherAETNA HMO
502418OtherNCPPO
VA6254110Medicaid
0700360OtherUNHC
34300003OtherBCBS OF DC
440156OtherANTHEM
540894297OtherGW-ONE HEALTH
4204387OtherAETNA
240947OtherALLIANCE
540894297OtherMAIL HANDLERS
0101038435OtherVA LICENSE
49D0861486OtherCLIA
49D0861486OtherCLIA