Provider Demographics
NPI:1952412058
Name:GLENN, DARAN G (MD)
Entity Type:Individual
Prefix:
First Name:DARAN
Middle Name:G
Last Name:GLENN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:671 HIOAKS RD STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4072
Mailing Address - Country:US
Mailing Address - Phone:804-272-5814
Mailing Address - Fax:804-560-0232
Practice Address - Street 1:611 WATKINS CENTRE PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4404
Practice Address - Country:US
Practice Address - Phone:804-464-1028
Practice Address - Fax:804-464-2931
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-11-04
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Provider Licenses
StateLicense IDTaxonomies
VA0101240434207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH86540Medicare UPIN