Provider Demographics
NPI:1538165501
Name:WILLIAMS, GLENN G (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S AYERS HILL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:PA
Mailing Address - Zip Code:16720-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 S AYERS HILL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:PA
Practice Address - Zip Code:16720-1012
Practice Address - Country:US
Practice Address - Phone:814-647-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060057L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF90793Medicare UPIN