Provider Demographics
NPI:1356414098
Name:ORTLEY, GLENN (DO)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:ORTLEY
Suffix:
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 1:950 S OCTORARA TRL
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-2100
Mailing Address - Country:US
Mailing Address - Phone:610-857-6639
Mailing Address - Fax:610-857-6649
Practice Address - Street 1:950 S OCTORARA TRL
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365
Practice Address - Country:US
Practice Address - Phone:610-857-6639
Practice Address - Fax:610-857-6649
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005509L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007004370Medicaid
PA007004370Medicaid
PAB35268Medicare UPIN