Provider Demographics
NPI:1598926164
Name:MONTEIRO, GLEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:D
Last Name:MONTEIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:390 VIRGINIA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:URBANNA
Mailing Address - State:VA
Mailing Address - Zip Code:23175-9903
Mailing Address - Country:US
Mailing Address - Phone:804-285-6020
Mailing Address - Fax:804-758-2765
Practice Address - Street 1:390 VIRGINIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:URBANNA
Practice Address - State:VA
Practice Address - Zip Code:23175-9903
Practice Address - Country:US
Practice Address - Phone:804-285-6020
Practice Address - Fax:804-758-2765
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA011602053207Q00000X
VA0101250080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherGROUP PTAN
VAC06115OtherGROUP PTAN