Provider Demographics
NPI:1821002221
Name:MILLER, GLENN GALBRAITH SR (DO)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:GALBRAITH
Last Name:MILLER
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 FAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:610-828-0358
Mailing Address - Fax:610-825-9665
Practice Address - Street 1:700 FAYETTE STREET
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428
Practice Address - Country:US
Practice Address - Phone:610-828-0358
Practice Address - Fax:610-825-9665
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004427L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
163356Medicare ID - Type Unspecified
D77439Medicare UPIN