Provider Demographics
NPI:1336168780
Name:SCHROYER, GLENN S (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:S
Last Name:SCHROYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 STATE ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6562
Mailing Address - Country:US
Mailing Address - Phone:518-566-0672
Mailing Address - Fax:518-566-0641
Practice Address - Street 1:675 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6562
Practice Address - Country:US
Practice Address - Phone:518-566-0672
Practice Address - Fax:518-566-0641
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02056839Medicaid
NYBA0306Medicare ID - Type Unspecified