Provider Demographics
NPI:1740707298
Name:GLASS, ROBYN
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 BROOKTREE RD STE 302
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:142 CLEARVIEW CIR STE 110
Practice Address - Street 2:SUITE 110
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1565
Practice Address - Country:US
Practice Address - Phone:724-283-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059236363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical