Glen R. Elliott, PH.D., M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

G44741 Issued in CA

Practice address

650 Clark Way
Palo Alto, CA 94304-2300

Phone

(650) 688-3649

Fax

(650) 688-3669

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289347200000",
    "number": "1104939503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 CLARK WAY",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943042300",
            "telephone_number": "650-688-3649",
            "fax_number": "650-688-3669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 CLARK WAY",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943042300",
            "telephone_number": "650-688-3649",
            "fax_number": "650-688-3669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "GLEN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "PH.D., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2010-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G44741",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "G44741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G447410",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Maurin Elis, NP
• Elite Transformations, a Professional Medical Corporation
• Elizabeth a. Herb, M.D., a Professional Corporation
• Bonney Louise Ellestad, M.ED.
• Seth Elliot
• Irmina Anna Elliott, MD
• Janette Elizabeth Elliott, RN, MS
• Gabriel Ellison, MD
• Darcie Ellyne, RD
• Yasmin Eltawil, MD

• Child & Adolescent Psychiatry Physician in Palo Alto, CA
• Providers in Palo Alto, CA by specialty
• Child & Adolescent Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.