Individual provider · Type 1 NPI
Glenda Prudencio, PA-C
Medical Physician Assistant · Glenn Dale, MD
NPI number
1902273584
Active
Practice location
12150 Annapolis Rd Ste 308
Glenn Dale, MD 20769-9183
Mailing address
1440 Channing St NE
Washington, DC 20018-2004
Other practice locations
- 14300 Gallant Fox Ln, Suite 118, Bowie, MD 20715-4003 · (301) 805-4348
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0110-005091 (VA) |
| Medical Physician Assistant Primary | 363AM0700X | C05930 (MD) |
Medical Physician Assistant: Definition to come...
Another provider at this address
Other medical physician assistant providers in Glenn Dale
About NPI 1902273584
Glenda Prudencio, PA-C's National Provider Identifier is 1902273584, issued on Aug 30, 2015. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Glenn Dale, MD. The record was last updated on Sep 20, 2019.