Provider Demographics
NPI:1649280652
Name:GLOVER, KAREN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:GLOVER
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 1:38713 TIERRA SUBIDA AVE
Mailing Address - Street 2:200-112
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4562
Mailing Address - Country:US
Mailing Address - Phone:661-349-8268
Mailing Address - Fax:661-362-1183
Practice Address - Street 1:833 AUTO CENTER DR
Practice Address - Street 2:STE A
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4488
Practice Address - Country:US
Practice Address - Phone:661-349-8268
Practice Address - Fax:661-362-1183
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2015-07-31
Deactivation Date:2006-08-22
Deactivation Code:
Reactivation Date:2006-09-15
Provider Licenses
StateLicense IDTaxonomies
CAA70211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A702110Medicaid
I01518Medicare UPIN
CA00A702110Medicaid