Provider Demographics
NPI:1972591121
Name:MEDEN, GLENN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:JOSEPH
Last Name:MEDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1450 SOM CENTER RD
Mailing Address - Street 2:#25
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2118
Mailing Address - Country:US
Mailing Address - Phone:440-446-1423
Mailing Address - Fax:440-446-1498
Practice Address - Street 1:6770 MAYFIELD RD
Practice Address - Street 2:#305
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-442-2554
Practice Address - Fax:440-442-3709
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-06-30
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Provider Licenses
StateLicense IDTaxonomies
OH35046953207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0554083Medicaid
A80827Medicare UPIN
OH0545947Medicare ID - Type Unspecified