Provider Demographics
NPI:1477602266
Name:GLOR, MEGAN MARIE CANALE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE CANALE
Last Name:GLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:CANALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1120 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1912
Mailing Address - Country:US
Mailing Address - Phone:315-475-5540
Mailing Address - Fax:315-475-5554
Practice Address - Street 1:1120 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1912
Practice Address - Country:US
Practice Address - Phone:315-475-5540
Practice Address - Fax:315-475-5554
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011864363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical