Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1790748754 Deactivated / Inactive NPI Male Practitioner

Eddie Glenn , PA

Physician Assistant • Syracuse, NY

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Eddie Glenn has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 10, 2006
NPI Deactivation Date August 09, 2017
Total Practice Duration ~11 Years of Practice (2006 – 2017)

Professional Overview & Biography Verified Profile Summary

Eddie Glenn, PA was a registered Physician Assistant practicing in Syracuse, NY. Throughout an active medical career spanning 11 years, Eddie Glenn provided care at the practice location at 819 S SALINA ST until profile deactivation on 2017-08-09.

Practice Location & Contact Primary Location

Practice Address

819 S Salina St

Syracuse, NY 132023536

Telephone 3154767921
Fax 3154741448
Associated Practice Facility / Clinic
🏢 Syracuse Community Pharmacy Facility NPI 1184797854

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Syracuse, NY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.3 Yrs
State Avg: 12.0 Yrs
Regional Practice Density
333 Specialists

Practicing in Syracuse, NY (15701 Statewide)

Telehealth Adoption Rate
9.9% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License NY 006732

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
NPI 1023070133

Doctor of Dental Surgery

Elizabeth Mashaw , LPN

Licensed Practical Nurse

NPI 1023421690

Licensed Practical Nurse

Tafiea Stokes , NP

Nurse Practitioner

NPI 1023459534

Nurse Practitioner

Dr. George Stanley , MD

Obstetrics & Gynecology

NPI 1043201973

Doctor of Medicine (M.D.)

NPI 1043532476

Licensed Clinical Social Worker

NPI 1053378612

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
⚠️
NPI Profile Deactivated August 09, 2017

Record deactivated on August 09, 2017

NPI Profile Active April 20, 2011

NPI status registered as active in NPPES database

📍
Updated Practice Location April 20, 2011

Registered at 819 S SALINA ST, SYRACUSE, NY 132023536 (Tel: 3154767921)

📍
Updated Business Mailing Address April 20, 2011

Registered at 251 SALINA MEADOWS PKWY, SUITE 100, SYRACUSE, NY 132124584 (Tel: 3154642096)

👤
Provider Name / Credentials Updated April 20, 2011

Recorded as EDDIE GLENN, PA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 20, 2011

Physician Assistant (License #006732 in NY)

🟢
Initial NPI Registration & Enumeration April 10, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Eddie Glenn. Be the first to share your experience!

Sign in to leave a review for Eddie Glenn

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1790748754
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 10, 2006
Last Update: April 20, 2011
Deactivation Date: August 09, 2017

Mailing Address

251 Salina Meadows Pkwy, Suite 100

Syracuse, NY 132124584

Phone: 3154642096

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.