Provider Demographics
NPI:1447289970
Name:MCLAUGHLIN, GLENN W (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:W
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:305 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1900
Mailing Address - Country:US
Mailing Address - Phone:406-563-8686
Mailing Address - Fax:406-563-8691
Practice Address - Street 1:305 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-1900
Practice Address - Country:US
Practice Address - Phone:406-563-8686
Practice Address - Fax:406-563-8691
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-045226207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1447289970OtherNPI
OHD08022Medicare UPIN
OH0747357Medicaid