Provider Demographics
NPI:1710999529
Name:GLODOWSKI, JUSTIN RORIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RORIE
Last Name:GLODOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 DARRINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8158
Mailing Address - Country:US
Mailing Address - Phone:919-852-3999
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:1021 DARRINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8158
Practice Address - Country:US
Practice Address - Phone:919-852-3999
Practice Address - Fax:919-378-9114
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5629207Q00000X
NC2013-01803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX56290Medicaid
NCNCE459AMedicare UPIN
CA5281540001Medicare NSC
CA00G561780Medicare PIN
A10688Medicare UPIN
CA020A56290Medicare PIN