Providence, Glen Kenneth

Providence, Glen Kenneth is an individual health care provider with primary practice located at 197 E Silver St Suite 2, Sharon PA 16146-2186. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Providence, Glen Kenneth can be contacted via phone (724) 342-6604.

Contact Information

Primary practice address
197 E Silver St Suite 2 Sharon PA 16146-2186
Phone: (724) 342-6604
Fax: (724) 342-1601
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD443812 Pennsylvania

Profile Details

NPI number 1952619975
LBN Legal business name Providence, Glen Kenneth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 24th, 2010
Last updated Dec 11th, 2013 - about 11 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 1952619975 NPPES
Pennsylvania MEDICAID 1026452400001
Pennsylvania MEDICAID 0059701
Pennsylvania Other P010166

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