Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | MD049823L | PA |
NPI | 1043325657 |
---|---|
Provider Name | Glenn B. Mieszkalski |
First Address | Harrisburg, PA 17104-1612 |
Second Address | Harrisburg, PA 17109-5317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 27/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101107828 | (05) | PA |
F80710 | (02) | PA |