Active NPI
Glenn Michelson, M.D.
- Hematology & Oncology Physician
- Berkeley, CA
National Provider Identifier
1679947949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- G85101
- Practice address
- 91 Bolivar Dr
Berkeley, CA 94710-2210 - Phone
- (510) 647-4252
- Fax
- (510) 548-8014
- NPI assigned
- Nov 23, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | G85101 | CA | Primary |
Addresses
Primary practice location
91 Bolivar Dr
Berkeley, CA 94710-2210
Mailing address
91 Bolivar Dr
Berkeley, CA 94710-2210
Phone (510) 647-4252
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G85101 | CA | MD | Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471996800000",
"number": "1679947949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91 BOLIVAR DR",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947102210",
"telephone_number": "510-647-4252",
"fax_number": "510-548-8014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91 BOLIVAR DR",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947102210",
"telephone_number": "510-647-4252",
"fax_number": "510-548-8014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHELSON",
"first_name": "GLENN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-23",
"last_updated": "2016-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "CA",
"license": "G85101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.