Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OT011552 | PA |
N | 111NI0900X | Internist | OT011552 | PA |
Y | 207RH0002X | Hospice and Palliative Medicine | OS015150 | PA |
NPI | 1043451354 |
---|---|
Provider Name | Dr. Glen David Digwood |
First Address | Danville, PA 17822-4903 |
Second Address | Scranton, PA 18510-2369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2009 |
Last Update Date | 07/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1024860450001 | (05) | PA |