Provider Demographics
NPI:1063157428
Name:GLOTFELTY, SAMANTHA SOAAD (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SOAAD
Last Name:GLOTFELTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:SOAAD
Other - Last Name:ELFANAGELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 860912
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0912
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:1101 MOULTON & PARSONS DR
Practice Address - Street 2:
Practice Address - City:ST JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-0460
Practice Address - Country:US
Practice Address - Phone:507-375-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCGLOT-8HAPDL390200000X
MN79313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program