Provider Demographics
NPI:1841212206
Name:MARCH, GLENVILLE ANTHONY JR (MD)
Entity Type:Individual
Prefix:
First Name:GLENVILLE
Middle Name:ANTHONY
Last Name:MARCH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 CENTER DR W
Mailing Address - Street 2:SUITE790
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1535
Mailing Address - Country:US
Mailing Address - Phone:310-216-2311
Mailing Address - Fax:310-216-2310
Practice Address - Street 1:4640 LINCOLN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292
Practice Address - Country:US
Practice Address - Phone:310-822-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52074207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A520740OtherMEDICAL PPIN #
CAG04074Medicare UPIN
CAWA52074AMedicare ID - Type UnspecifiedPPIN #