Provider Demographics
NPI:1730189630
Name:MILLER, GLENN D (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:D
Last Name:MILLER
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 1:490 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-359-5822
Mailing Address - Fax:412-359-6620
Practice Address - Street 1:490 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-359-5822
Practice Address - Fax:412-359-6620
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044831L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012574570009Medicaid
OH2022831Medicaid
WV3005035000Medicaid
WV3005035000Medicaid
PA692291NJ5Medicare PIN
PAP00097781Medicare PIN
OH2022831Medicaid