Provider Demographics
NPI:1801995485
Name:SUBIN, GLEN (MD)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:SUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9700
Mailing Address - Country:US
Mailing Address - Phone:910-295-4500
Mailing Address - Fax:
Practice Address - Street 1:25 MCCASKILL RD W
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9029
Practice Address - Country:US
Practice Address - Phone:910-295-4500
Practice Address - Fax:910-235-0852
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92145207X00000X
COCDR.0004337207X00000X, 207XS0106X
TXV0314207X00000X
NHEL11398207X00000X
NH24138207X00000X
NC30866207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC210770DMedicare PIN