Provider Demographics
NPI:1245329739
Name:SANDBERG, GLENN DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:DOUGLAS
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1123 CHERRY POINT RD
Mailing Address - Street 2:
Mailing Address - City:WEST RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20778-9780
Mailing Address - Country:US
Mailing Address - Phone:202-782-2804
Mailing Address - Fax:
Practice Address - Street 1:ARMED FORCES INSTITUTE OF PATHOLOGY
Practice Address - Street 2:14TH AND ALASKA
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20306-0001
Practice Address - Country:US
Practice Address - Phone:202-782-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65358207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology