Provider Demographics
NPI:1144492372
Name:TOOMAYAN, GLEN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:ALAN
Last Name:TOOMAYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LASSWADE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-6703
Mailing Address - Country:US
Mailing Address - Phone:910-420-2932
Mailing Address - Fax:
Practice Address - Street 1:30 MEMORIAL DRIVE
Practice Address - Street 2:PINEHURST RADIOLOGY
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-295-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005002712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2073382AOtherMEDICARE
NC2073382BOtherMEDICARE