Provider Demographics
NPI:1649283821
Name:GLENN, ROBERT NORMAN (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:NORMAN
Last Name:GLENN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9376 ATLEE STATION RD
Mailing Address - Street 2:HANOVER FAMILY PHYSICIANS PC
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116
Mailing Address - Country:US
Mailing Address - Phone:804-730-0990
Mailing Address - Fax:804-730-8752
Practice Address - Street 1:9376 ATLEE STATION RD
Practice Address - Street 2:HANOVER FAMILY PHYSICIANS PC
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-730-0990
Practice Address - Fax:804-730-8752
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000798103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA07701241Medicaid
VAP31241Medicare UPIN