Provider Demographics
NPI:1467430553
Name:GIANINI, GLENN D (DO)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:D
Last Name:GIANINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5739
Mailing Address - Country:US
Mailing Address - Phone:207-623-1322
Mailing Address - Fax:
Practice Address - Street 1:5 CALDWELL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5739
Practice Address - Country:US
Practice Address - Phone:207-623-1322
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1101207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEF54089OtherHARVARD PILGRIM
ME007722OtherANTHEM
ME1041115OtherAETNA
ME2071665OtherCIGNA
ME2071665OtherCIGNA
MEF54089Medicare UPIN