TARA JACKSON GLENN MD NPI 1992060974

NPI Information

NPI: 1992060974
Provider Name: TARA JACKSON GLENN, MD
Classification: Pediatrics - 2080N0001X
Entity Type: Individual

Specialization: Neonatal-Perinatal Medicine

PECOS Registration: Yes

Address:
9300 CAMPUS POINT DR
LA JOLLA, CA
ZIP 92037
Phone: (858) 249-5800
Get Directions

Tara Jackson Glenn, MD is a neonatal-perinatal medicine pediatrics in La Jolla, CA. The provider is a pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. Tara Jackson Glenn, MD NPI is 1992060974. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

9300 CAMPUS POINT DR
LA JOLLA, CA
ZIP 92037-300
Phone: (858) 249-5800

The NPI 1992060974 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/6/2012 and was last updated on 4/8/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		35-126046	OHIO	No
2	208000000X	Pediatrics		A170207	CALIFORNIA	No
3	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	A170207	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0148250	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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