Provider Demographics
NPI:1336168459
Name:LYTLE-GLOVER, KAREN J (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:LYTLE-GLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:J
Other - Last Name:LYTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4745 OGLETOWN STANTON RD
Mailing Address - Street 2:MAP1, SUITE 207
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2067
Mailing Address - Country:US
Mailing Address - Phone:302-368-9000
Mailing Address - Fax:302-368-9004
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:MAP1, SUITE 207
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-368-9000
Practice Address - Fax:302-368-9004
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004764207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000714601Medicaid
DE0000714601Medicaid
874217M82Medicare ID - Type Unspecified