Provider Demographics
NPI:1477588291
Name:TREISMAN, GLENN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:TREISMAN
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:JOHNS HOPKINS HOSPITAL
Mailing Address - Street 2:600 N. WOLFE ST. - MEYER 119
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-7119
Mailing Address - Country:US
Mailing Address - Phone:410-955-6328
Mailing Address - Fax:410-367-2063
Practice Address - Street 1:OHNS HOPKINS HOSPITAL
Practice Address - Street 2:600 N. WOLFE ST. - MEYER 119
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-7119
Practice Address - Country:US
Practice Address - Phone:410-955-6328
Practice Address - Fax:410-367-2063
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD383602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD083831400Medicaid
MDH897AL17Medicare ID - Type Unspecified