Provider Demographics
NPI:1528038098
Name:GLESSNER, CAROL A (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:GLESSNER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:154 EXTON SQUARE MALL
Mailing Address - Street 2:MAIN LINE HEALTH CENTER
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2440
Mailing Address - Country:US
Mailing Address - Phone:484-565-8500
Mailing Address - Fax:610-280-1595
Practice Address - Street 1:154 EXTON SQUARE MALL
Practice Address - Street 2:MAIN LINE HEALTH CENTER
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2440
Practice Address - Country:US
Practice Address - Phone:484-565-8500
Practice Address - Fax:610-280-1595
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD-052246-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E51244Medicare UPIN
E51244Medicare UPIN
PA117915HK1Medicare PIN