Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | OS002648L | PA |
Y | 208D00000X | General Practice Physician | OS002648L | PA |
NPI | 1104989482 |
---|---|
Provider Name | Dr. Richard Saul Glick |
First Address | Dresher, PA 19025-1023 |
Second Address | Dresher, PA 19025-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 12/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000090349 | HIGHMARK BLUE SHIELD ID (01) | PA |
0045371000 | HMO ID (01) | PA |
C29526 | (02) | PA |