Provider Demographics
NPI:1508867482
Name:MOYER, GLENN E (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:E
Last Name:MOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:804 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1178
Mailing Address - Country:US
Mailing Address - Phone:610-868-2235
Mailing Address - Fax:610-868-9453
Practice Address - Street 1:804 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1178
Practice Address - Country:US
Practice Address - Phone:610-868-2235
Practice Address - Fax:610-868-9453
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD 017003E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
441183668OtherRR MEDICARE
PA00686680Medicaid
PA00686680Medicaid
B34045Medicare UPIN