Provider Demographics
NPI:1972670933
Name:GLYNN, MARTIN J (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:GLYNN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:STE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1321
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:ABINGTON MEMORIAL HOSPITAL
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-4213
Practice Address - Fax:215-481-3095
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-08-30
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Provider Licenses
StateLicense IDTaxonomies
PAMD019141E207R00000X, 207R00000X
NJMA062059207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000796162Medicaid
E63511Medicare UPIN
E63511Medicare UPIN