Provider Demographics
NPI:1467410993
Name:HALL, GLENNIS RM (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENNIS
Middle Name:RM
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:205 NEWTOWN RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-5207
Mailing Address - Country:US
Mailing Address - Phone:215-773-9564
Mailing Address - Fax:215-773-9602
Practice Address - Street 1:100 MEDICAL CAMPUS DR
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1259
Practice Address - Country:US
Practice Address - Phone:215-773-9564
Practice Address - Fax:215-773-9602
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD055770L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001546932Medicaid
PAG16293Medicare UPIN
PA001546932Medicaid