Provider Demographics
NPI:1922352491
Name:KURKA, GLENN A
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:KURKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WARDS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2142
Mailing Address - Country:US
Mailing Address - Phone:434-237-2600
Mailing Address - Fax:304-324-8308
Practice Address - Street 1:2300 WARDS RD
Practice Address - Street 2:SUITE F
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2142
Practice Address - Country:US
Practice Address - Phone:434-237-2600
Practice Address - Fax:304-324-8308
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2466237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist