Provider Demographics
NPI:1841238086
Name:GLENNEY, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:GLENNEY
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 1:6675 MOUNT CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8111
Mailing Address - Country:US
Mailing Address - Phone:540-772-1678
Mailing Address - Fax:
Practice Address - Street 1:18080 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:VA
Practice Address - Zip Code:24066-5482
Practice Address - Country:US
Practice Address - Phone:540-254-1239
Practice Address - Fax:540-254-1267
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-238434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010267013Medicaid
VA010348412Medicaid
VA195195OtherANTHEM
VA239711OtherANTHEM
VA195195OtherANTHEM
VA010348412Medicaid
012696C95Medicare PIN
VA018012C18Medicare PIN
VAP00322558Medicare PIN