Provider Demographics
NPI:1790727857
Name:HERMAN, GLENN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROUTE 73 N
Mailing Address - Street 2:40 LAKE CENTER DRIVE SUITE 201A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3425
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0346
Practice Address - Street 1:100 BOWMAN DR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9612
Practice Address - Country:US
Practice Address - Phone:856-247-3328
Practice Address - Fax:856-247-3276
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04033300174400000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ271348772OtherTAX ID
NJ2K9098OtherHEALTHNET #
NJ221494442OtherTAX ID #
NJ60028477OtherHORIZON NJ HEALTH #
NJ8219768OtherGHI PPO
NJ0075851000OtherAMERIHEALTH #
NJ3422508OtherAETNA HMO #
NJP3226875OtherOXFORD #
NJ22280OtherAMERIGROUP #
NJ4234565OtherAETNA PPO #
NJ22280OtherAMERIGROUP #