Provider Demographics
NPI:1790746972
Name:GLANZ, JESSICA B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:B
Last Name:GLANZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2012 S TOLLGATE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5900
Mailing Address - Country:US
Mailing Address - Phone:410-569-5151
Mailing Address - Fax:410-569-1131
Practice Address - Street 1:2012 S TOLLGATE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5900
Practice Address - Country:US
Practice Address - Phone:410-569-5151
Practice Address - Fax:410-569-1131
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055651363A00000X
MDC02458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA248779D7JMedicare PIN