Provider Demographics
NPI:1790798965
Name:GLICK, HOWARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:A
Last Name:GLICK
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 1:21001 SYCOLIN RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:703-858-7838
Mailing Address - Fax:703-858-9697
Practice Address - Street 1:21001 SYCOLIN RD
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4073
Practice Address - Country:US
Practice Address - Phone:703-858-7838
Practice Address - Fax:703-858-9697
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010324532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540948306Medicaid
VA293477Medicaid
VA004945140Medicaid
VA293477Medicaid