DR. GLEN R. ELLIOTT (NPI# 1104939503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104939503 |
| Entity Type | Individual |
| Full Name | DR. GLEN R. ELLIOTT |
| Credential | PH.D., M.D. |
| Practice Address |
650 Clark Way Palo Alto CA 94304-2300 |
| Practice Telephone | 6506883649 |
| Practice Fax Number | 6506883669 |
| Mailing Telephone | 6506883649 |
| Mailing Fax Number | 6506883669 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2010-11-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
G44741 | CA | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
G44741 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G447410 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851383830 | Glen W Elliott | Optometrist | 825 5th Ave, Suite 102, Chambersburg, PA 17201-4213 | 2005-08-17 |
| Street Address |
650 CLARK WAY |
| City | PALO ALTO |
| State | CA |
| Zip Code | 94304-2300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124631197 | Sarah Newman | Marriage & Family Therapist | 650 Clark Way, Palo Alto, CA 94304-2300 | 2020-08-28 |
| 1992318679 | Nicole Wdowiak | Speech-Language Pathologist | 650 Clark Way, Palo Alto, CA 94304-2300 | 2020-08-24 |
| 1003436023 | Holly Weldon | Student in an Organized Health Care Education/Training Program | 650 Clark Way, Palo Alto, CA 94304-2300 | 2020-04-20 |
| 1548889629 | Cara Marie Diclemente | Student in an Organized Health Care Education/Training Program | 650 Clark Way, Palo Alto, CA 94304-2300 | 2020-04-09 |
| 1568091791 | Lauren Adelyn Cohen | Student in an Organized Health Care Education/Training Program | 650 Clark Way, Palo Alto, CA 94304-2300 | 2020-04-08 |
| 1053942862 | Eric Loughhead | Counselor | 650 Clark Way, Palo Alto, CA 94304-2300 | 2020-01-30 |
| 1558902502 | Moran Shoham | Student in an Organized Health Care Education/Training Program | 650 Clark Way, Palo Alto, CA 94304-2300 | 2019-10-01 |
| 1235797705 | Dariah Simone Brown | Counselor | 650 Clark Way, Palo Alto, CA 94304-2300 | 2019-05-30 |
| 1174187934 | Virginia Diane Peisch | Student in an Organized Health Care Education/Training Program | 650 Clark Way, Palo Alto, CA 94304-2300 | 2019-04-26 |
| 1083278923 | Madison Sunnquist | Counselor | 650 Clark Way, Palo Alto, CA 94304-2300 | 2019-04-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477170611 | Richard Engdahl | Specialist/Technologist, Other | 820 Quarry Road, Mc1078 Hf006, Palo Alo, CA 94304 | 2020-07-04 |
| 1720603582 | Lily Wenya Zhou | Psychiatry & Neurology | 780 Welch Road, Suite 350, Stanford Stroke Center, Palo Alto, CA 94304 | 2020-06-08 |
| 1033738521 | Perry Seo Choi | Student in an Organized Health Care Education/Training Program | Dept of Cardiothoracic Surgery, Falk Building, 870 Quarry Rd, Palo Alto, CA 94304 | 2020-04-14 |
| 1073150355 | Tara Mcdermott | Nurse Practitioner | 500 Pasteur Drive, Cardiovascular Intensive Care Unit, Palo Alto, CA 94304 | 2019-12-05 |
| 1811542723 | Mark Henry Chubb | Pediatrics | Stanford Children's Health, 725 Welch Road, Palo Alto, CA 94304 | 2019-08-07 |
| 1194285114 | Cora Steindl | Nurse Practitioner | 300 Pasteur Drive Rm H2512, Stanford, CA 94304 | 2019-03-25 |
| 1407333057 | Deborah Menet Landi | Social Worker | Lucile Packard Children's Hospital Stanford, 725 Welch, Mc 5933, Palo Alto, CA 94304 | 2018-07-26 |
| 1982100798 | Jonathan Hootman | Student in an Organized Health Care Education/Training Program | 900 Quarry Road Extension, Palo Alto, CA 94304 | 2018-04-02 |
| 1093234254 | Adam C Maclellan | Psychiatry & Neurology | Stanford Stroke Center, 780 Welch Road, Suite 350, Palo Alto, CA 94304 | 2017-09-19 |
| 1194248153 | Chanel Beaudoin Cloutier | Plastic Surgery | 770 Welch Road, Suite 400, Palo Alto, CA 94304 | 2017-07-21 |
| Find all providers in zip 94304 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255871182 | Carol R Harrus | Psychiatry & Neurology | 517 Patricia Ln, Palo Alto, CA 94303-2856 | 2017-02-25 |
| 1295059871 | John Leikauf | Psychiatry & Neurology | 630 University Ave Ste A, Palo Alto, CA 94301-2019 | 2010-03-25 |
| 1588786297 | Harold Robert Novotny | Psychiatry & Neurology | 1736 Oak Creek Drive, Apt 405, Palo Alto, CA 94304-2115 | 2007-04-04 |
| 1609844539 | Sarita Pulkit Patel | Psychiatry & Neurology | 550 Hamilton Avenue, Suite 210, Palo Alto, CA 94301 | 2006-03-08 |
| 1144675851 | Tatiana Mefford | Psychiatry & Neurology | 401 Quarry Rd, Palo Alto, CA 94304-1419 | 2016-05-01 |
| 1457715542 | Psychiatric Center for Human Concerns | Psychiatry & Neurology | 350 Cambridge Ave, Suite 200, Palo Alto, CA 94306-1550 | 2016-04-05 |
| 1467827741 | Tamar Green | Psychiatry & Neurology | 725 Welch Rd, Palo Alto, CA 94304-1601 | 2015-12-11 |
| 1376983379 | Nancy Leigh Hillis | Psychiatry & Neurology | 900 Welch Rd, Suite 203, Palo Alto, CA 94304-1805 | 2013-07-05 |
| 1548552979 | Thomas Butler | Psychiatry & Neurology | 401 Quarry Rd, Palo Alto, CA 94304-1419 | 2011-05-03 |
| 1841426343 | Soudabeh Givrad | Psychiatry & Neurology | 725 Welch Rd, Palo Alto, CA 94304-1601 | 2009-06-10 |
| Find all providers in PALO ALTO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.