Provider Demographics
NPI:1851363097
Name:GLICKMAN, MEREDITH (MD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:#201
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3003
Mailing Address - Country:US
Mailing Address - Phone:805-493-1964
Mailing Address - Fax:805-492-0614
Practice Address - Street 1:430 AVENIDA DE LOS ARBOLES
Practice Address - Street 2:#201
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3003
Practice Address - Country:US
Practice Address - Phone:805-493-1964
Practice Address - Fax:805-492-0614
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061852208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics