Provider Demographics
NPI:1568555274
Name:DEMPSEY, GLENN B (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:B
Last Name:DEMPSEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:822 MONTGOMERY AVENUE
Mailing Address - Street 2:STE 100
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:610-664-4433
Mailing Address - Fax:640-664-5290
Practice Address - Street 1:9892 BUSTLETON AVENUE
Practice Address - Street 2:STE 204 MOSS PLAZA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-676-2464
Practice Address - Fax:215-676-5536
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD058798L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0102925504Medicaid
PA865316Medicare ID - Type Unspecified
PA0102925504Medicaid