Provider Demographics
NPI:1326023995
Name:GLASS, SAMUEL L (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:L
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:120 MAIN ST
Mailing Address - Street 2:PO BOX 580
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1507
Mailing Address - Country:US
Mailing Address - Phone:814-536-5343
Mailing Address - Fax:814-536-1525
Practice Address - Street 1:120 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1507
Practice Address - Country:US
Practice Address - Phone:814-536-5343
Practice Address - Fax:814-536-1525
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA022733E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012572050001Medicaid
PA0012572050001Medicaid
C92329Medicare UPIN