Provider Demographics
NPI:1538431465
Name:STOLTZFUS, GLENN B (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:B
Last Name:STOLTZFUS
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 1:1345 SOMERSET CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-5063
Mailing Address - Country:US
Mailing Address - Phone:574-534-1813
Mailing Address - Fax:
Practice Address - Street 1:1345 SOMERSET CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-5063
Practice Address - Country:US
Practice Address - Phone:574-534-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023067A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics