Provider Demographics
NPI:1437140837
Name:GLUCK, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:GLUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LOWTHER ST
Mailing Address - Street 2:INTERNISTS OF CENTRAL PA LTD
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-2045
Mailing Address - Country:US
Mailing Address - Phone:717-774-1366
Mailing Address - Fax:717-774-4232
Practice Address - Street 1:108 LOWTHER ST
Practice Address - Street 2:INTERNISTS OF CENTRAL PA LTD
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-2045
Practice Address - Country:US
Practice Address - Phone:717-774-1366
Practice Address - Fax:717-774-4232
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016748E207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006339620001Medicaid
C29761Medicare UPIN
PA0006339620001Medicaid