Individual
GLEN P. IMLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
98 STATE ST, PROCTORVILLE, OH 45669-8163
(740) 886-9403
(740) 446-5153
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 886-9403
(740) 446-5153
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
20826
WV
208100000X
Physical Medicine & Rehabilitation Physician
Primary
35-08-0873
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185246
UNISON MEDICAID
OH
01
—
000000227912
ANTHEM BCBS
—
01
—
001714143
MOUNTAIN STATE BCBS
—
05
—
2003261000
—
WV
01
—
2333906
MOLINA MEDICAID
OH
05
—
2333906
—
OH
01
—
250013535
RR MEDICARE
—
01
—
310917085124
CARESOURCE MEDICAID
OH
Enumeration date
05/19/2006
Last updated
01/21/2021
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