Basic Information
| Provider Information | |||||||||
| NPI: | 1992455919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLYNN | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MB BCH BAO | ||||||||
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| Mailing Information | |||||||||
| Address1: | BRIGHAM AND WOMEN'S HOSPITAL | ||||||||
| Address2: | 75 FRANCIS STREET | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177325500 | ||||||||
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| Practice Location | |||||||||
| Address1: | QUERN, THORNBACK HILL | ||||||||
| Address2: | THORNBACK HILL | ||||||||
| City: | KILKENNY | ||||||||
| State: | KILKENNY | ||||||||
| PostalCode: | R95PV06 | ||||||||
| CountryCode: | IE | ||||||||
| TelephoneNumber: | 0851339469 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2022 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.