Provider Demographics
NPI:1922047927
Name:SKWERER, GLENN ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN ALLEN
Middle Name:
Last Name:SKWERER
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 1:1024 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1029
Mailing Address - Country:US
Mailing Address - Phone:617-489-7975
Mailing Address - Fax:
Practice Address - Street 1:30 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4713
Practice Address - Country:US
Practice Address - Phone:617-473-0993
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA739492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry