Provider Demographics
NPI:1184612046
Name:WHITMAN, GLENN (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:WHITMAN
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 1:1800 ORLEANS ST
Mailing Address - Street 2:SHEIKH ZAYED 7107 - CARDIAC SURGERY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0010
Mailing Address - Country:US
Mailing Address - Phone:410-955-2800
Mailing Address - Fax:410-955-3809
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:SHEIKH ZAYED 7107 - CARDIAC SURGERY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-955-2800
Practice Address - Fax:410-955-3809
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 024838E208G00000X
MDD54191208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012133450010Medicaid
MD173100901Medicaid
MD616576Y19Medicare PIN
MD173100901Medicaid
MD158903Y19Medicare PIN
MD158903Y19Medicare PIN