Active NPI
Mark Dwight Glenn, MD
- Psychiatry Physician
- Myrtle Beach, SC
National Provider Identifier
1740294925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 13811
- Practice address
- 3381 Phillis Blvd
Myrtle Beach, SC 29577-1560 - Phone
- (843) 477-0177
- Fax
- (843) 839-1791
- NPI assigned
- Jul 27, 2006
- Last updated
- Sep 23, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 13811 | SC | Primary |
Addresses
Primary practice location
3381 Phillis Blvd
Myrtle Beach, SC 29577-1560
Mailing address
3381 Phillis Blvd
Myrtle Beach, SC 29577-1560
Phone (843) 477-0177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13811 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442966400000",
"number": "1740294925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3381 PHILLIS BLVD",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295771560",
"telephone_number": "843-477-0177",
"fax_number": "843-839-1791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3381 PHILLIS BLVD",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295771560",
"telephone_number": "843-477-0177",
"fax_number": "843-839-1791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "MARK",
"middle_name": "DWIGHT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2015-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "SC",
"license": "13811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.