Basic Information
| Provider Information | |||||||||
| NPI: | 1588127088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLANZ | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 MACNIDER BUILDING CB #7220 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661505 | ||||||||
| FaxNumber: | 9199667299 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING HILL DRIVE | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849741000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2019 | ||||||||
| LastUpdateDate: | 07/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 250567 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 250567 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.