Provider Demographics
NPI:1316197080
Name:MISKE, GLEN RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:RICHARD
Last Name:MISKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 645532
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264-5253
Mailing Address - Country:US
Mailing Address - Phone:740-792-4220
Mailing Address - Fax:740-275-4472
Practice Address - Street 1:243 THREE SPRINGS DR STE 5A
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3839
Practice Address - Country:US
Practice Address - Phone:740-792-4220
Practice Address - Fax:740-275-4472
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-010883-L207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology