Provider Demographics
NPI:1821073990
Name:DOBECKI, GLENN ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALLAN
Last Name:DOBECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 BASSETT BROOK LN
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4602
Mailing Address - Country:US
Mailing Address - Phone:781-585-6012
Mailing Address - Fax:781-331-3242
Practice Address - Street 1:10 BASSETT BROOK LN
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4602
Practice Address - Country:US
Practice Address - Phone:781-585-6012
Practice Address - Fax:781-331-3242
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA30427207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C27048Medicare ID - Type Unspecified
A53946Medicare UPIN