Provider Demographics
NPI:1881661213
Name:POMPEY, GLENDORA G (MD)
Entity Type:Individual
Prefix:MRS
First Name:GLENDORA
Middle Name:G
Last Name:POMPEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:GLENDORA
Other - Middle Name:
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 746720
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6720
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:4401 W WESTERN AVE STE C
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-2645
Practice Address - Country:US
Practice Address - Phone:574-725-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01089788A207Q00000X
MI4301062314208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3284829 10Medicaid
MIP00351062OtherRAIL ROAD MEDICARE PIN
MIP00351062OtherRAIL ROAD MEDICARE PIN
MIP38380001Medicare PIN