Individual
STEPHAN R GLICKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
564 W BROAD ST, HAZLETON, PA 18201-6108
(570) 501-6400
(570) 453-2353
Mailing address
PO BOX 783311, PHILADELPHIA, PA 19178-3311
(484) 884-4500
(484) 884-0699
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
75192
MA
208000000X
Pediatrics Physician
Primary
MD433646
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102115501-0005
—
PA
05
—
1021155010001
—
PA
05
—
2860426
—
OH
05
—
3810012098
—
WV
Enumeration date
08/22/2006
Last updated
02/13/2020
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