Provider Demographics
NPI:1780854885
Name:GLENN G. MARINELLI MD PA
Entity Type:Organization
Organization Name:GLENN G. MARINELLI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-486-4088
Mailing Address - Street 1:205 STEEPLE CHASE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4053
Mailing Address - Country:US
Mailing Address - Phone:443-486-4088
Mailing Address - Fax:443-486-4086
Practice Address - Street 1:205 STEEPLE CHASE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4053
Practice Address - Country:US
Practice Address - Phone:443-486-4088
Practice Address - Fax:443-486-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22534207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty