Provider Demographics
NPI:1265410781
Name:ATILANO, GLENDA (MD)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:ATILANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 NARROW LANE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2971
Mailing Address - Country:US
Mailing Address - Phone:334-613-7080
Mailing Address - Fax:334-613-7081
Practice Address - Street 1:4371 NARROW LANE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2971
Practice Address - Country:US
Practice Address - Phone:334-613-7080
Practice Address - Fax:334-613-7081
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630813275OtherCOMMERICAL GROUP
AL051540503OtherBCBS
AL0403254OtherUNITED HEALTHCARE
AL51028509OtherBCBS
AL630813275OtherCOMMERICIAL PRV
AL630900038Medicaid
AL630902038Medicaid
AL630813275OtherWORK COMP
ALP00426540OtherRAIL ROAD MEDICARE
AL009910777Medicaid
AL51028438OtherBCBS
AL009910777Medicaid
ALP00042646Medicare ID - Type UnspecifiedRAILROAD
AL051559298Medicare PIN
AL51028509OtherBCBS