Provider Demographics
NPI:1609107069
Name:CANNON, GLENN MARTIN JR (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:MARTIN
Last Name:CANNON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:FORBES TOWER, SUITE 9055
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-647-3087
Mailing Address - Fax:412-647-4486
Practice Address - Street 1:1 CHILDRENS HOSPITAL DR
Practice Address - Street 2:4401 PENN AVENUE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1529
Practice Address - Country:US
Practice Address - Phone:412-692-7932
Practice Address - Fax:412-692-7939
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
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Provider Licenses
StateLicense IDTaxonomies
PAMD419882208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology