Provider Demographics
NPI:1447206107
Name:FINNEY, GLEN RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:RAYMOND
Last Name:FINNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GLEN
Other - Middle Name:R
Other - Last Name:FINNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 NORTH ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17852-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 EAST MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-3731
Practice Address - Country:US
Practice Address - Phone:570-808-6026
Practice Address - Fax:570-808-3208
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME933832084N0400X
PAMD4548852084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273155000Medicaid
U5377ZMedicare PIN
PA418642Medicare PIN
FL273155000Medicaid