Provider Demographics
NPI:1336337542
Name:GLENN D LITTENBERG MD INC
Entity Type:Organization
Organization Name:GLENN D LITTENBERG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LITTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-449-9920
Mailing Address - Street 1:630 S RAYMOND AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3278
Mailing Address - Country:US
Mailing Address - Phone:626-449-9920
Mailing Address - Fax:626-578-7366
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-449-9920
Practice Address - Fax:626-578-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27849207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG8342OtherRAILROAD MEDICARE PTAN
CA00G278490Medicaid
CA00G278490Medicaid