Provider Demographics
NPI:1740471416
Name:GLIENKE, CARL JONATHAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:JONATHAN
Last Name:GLIENKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:3059 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1433
Mailing Address - Country:US
Mailing Address - Phone:410-956-3394
Mailing Address - Fax:410-956-3324
Practice Address - Street 1:3059 SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1433
Practice Address - Country:US
Practice Address - Phone:410-956-3394
Practice Address - Fax:410-956-3324
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1095604363A00000X
MDC0008153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant