Provider Demographics
NPI:1740293901
Name:BRYNES, GLENN O (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:O
Last Name:BRYNES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2360 W JOPPA RD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4624
Mailing Address - Country:US
Mailing Address - Phone:410-296-5511
Mailing Address - Fax:
Practice Address - Street 1:2360 W JOPPA RD
Practice Address - Street 2:SUITE 223
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4624
Practice Address - Country:US
Practice Address - Phone:410-296-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD286772084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD01360Medicare UPIN