GLEN RIVERA (NPI# 1316052111) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316052111 |
| Entity Type | Individual |
| Full Name | GLEN RIVERA |
| Credential | PA-C |
| Practice Address |
7115 Guilford Dr Ste 202 Frederick MD 21704-5236 |
| Practice Telephone | 3016635922 |
| Mailing Telephone | 3016635922 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
C0006682 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
0110002571 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
102256 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1840 Amherst St, Winchester Medical Center/ Heart & Vascular Services, Winchester, VA 226012808 | 5405362575 |
| Street Address |
7115 GUILFORD DR STE 202 |
| City | FREDERICK |
| State | MD |
| Zip Code | 21704-5236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033110028 | Lloyd E Halvorson | Internal Medicine | 7115 Guilford Dr Ste 202, Frederick, MD 21704-5236 | 2005-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144747148 | Danah Jack | Physical Therapist | 4070 Atterbury Place, Frederick, MD 21704 | 2017-08-29 |
| 1568986891 | Amy Benjamin Slp | Speech-Language Pathologist | 8905 Amelung St, Frederick, MD 21704 | 2017-07-28 |
| 1104352368 | Mentor-maryland | Community/Behavioral Health | 5970 Frederick Crossing Lane, #202, Frederick, MD 21704 | 2017-05-10 |
| 1699193284 | Jiang Tan | Acupuncturist | 3520 Worthington Blvd #101, Frederick, MD 21704 | 2014-04-01 |
| 1326460817 | Jessica Lacayo | Nurse Practitioner | 3350 Worthington Boulevard, Urbana, MD 21704 | 2014-01-17 |
| 1588098818 | Kimberly Kaye Dipietro | Registered Nurse | 9006 Harris Street, Frederick, MD 21704 | 2013-08-22 |
| 1831432525 | Yuqing Meng | Pharmacist | 9317 Elgin Lane, Frederick, MD 21704 | 2013-04-01 |
| 1831446285 | Diane Marie Foland | Behavioral Analyst | 4235 Lafayette Street, Frederick, MD 21704 | 2012-08-03 |
| 1982932695 | Contemporary Therapeutic Services Inc | Community/Behavioral Health | 22 N Potomac Street, Ste 102, Hagerstown, MD 21704 | 2009-11-19 |
| 1942461181 | Hoa T K Lam | Dentist | 7360 Guilford Drive, Suite #102, Frederick, MD 21704 | 2008-06-20 |
| Find all providers in zip 21704 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801164066 | Atekelt Yilma Tadese | Physician Assistant | 46-b Thomas Johnson Drive, Suite 200, Frederick, MD 21702 | 2011-12-02 |
| 1619121472 | Barbara S. Rebele | Physician Assistant | 22 S Market St, Suite 6d, Frederick, MD 21701-5570 | 2008-11-06 |
| 1790954253 | Robert Paul Cathor | Physician Assistant | 56 Thomas Johnson Drive, Ste 110, Frederick, MD 21702-4599 | 2008-02-28 |
| 1598946006 | Justina A Bennett | Physician Assistant | 85 Thomas Johnson Ct, Suite C, Internal Medicine Specialists of Frederick, Frederick, MD 21702 | 2007-11-27 |
| 1104809342 | Tara Carson Jernejcic | Physician Assistant | 100 South Market Street, Frederick Community Action Agency, Frederick, MD 21701 | 2005-11-22 |
| 1376001214 | Lewis Edel Bertus | Physician Assistant | 610 Solarex Ct, Frederick, MD 21703-8624 | 2019-03-11 |
| 1922510056 | Paola Haros | Physician Assistant | 196 Thomas Johnson Dr, Frederick, MD 21702-4397 | 2017-10-30 |
| 1861867459 | Kelly Murray | Physician Assistant | 915 Toll House Ave Ste 103, Frederick, MD 21701-5911 | 2015-12-08 |
| 1295142388 | Rebecca Alyson Leonard | Physician Assistant | 63 Thomas Johnson Dr, Suite E, Frederick, MD 21702-4384 | 2014-07-21 |
| 1912332123 | Brittany Leigh Henry | Physician Assistant | 87 Thomas Johnson Dr Ste 101, Frederick, MD 21702-4427 | 2013-09-06 |
| Find all providers in FREDERICK | ||||
Please comment or provide details below to improve the information on GLEN RIVERA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.