Provider Demographics
NPI:1912058843
Name:NIXON, GLENFORD DELACY (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENFORD
Middle Name:DELACY
Last Name:NIXON
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 1:8 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-1906
Mailing Address - Country:US
Mailing Address - Phone:516-922-1056
Mailing Address - Fax:
Practice Address - Street 1:8 SOUTH RD
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-1906
Practice Address - Country:US
Practice Address - Phone:516-922-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173410207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01586341Medicaid
NYE66607Medicare UPIN
NY44K841Medicare ID - Type Unspecified