Glicken, Stephan R

Glicken, Stephan R is an individual health care provider with primary practice located at 564 W Broad St , Hazleton PA 18201-6108. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Glicken, Stephan R can be contacted via phone (570) 501-6400.

Contact Information

Primary practice address
564 W Broad St Hazleton PA 18201-6108
Phone: (570) 501-6400
Fax: (570) 453-2353
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 75192 Massachusetts
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD433646 Pennsylvania

Profile Details

NPI number 1225144041
LBN Legal business name Glicken, Stephan R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2006
Last updated Feb 13th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225144041 NPPES
Pennsylvania MEDICAID 1021155010001
Pennsylvania MEDICAID 3810012098
Pennsylvania MEDICAID 102115501-0005
Pennsylvania MEDICAID 2860426

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