Individual
GLEN RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
108 HOUSTON ST STE E, LEXINGTON, VA 24450-2455
(540) 463-2227
Mailing address
108 HOUSTON ST STE E, LEXINGTON, VA 24450-2455
(540) 463-2227
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002571
VA
363AM0700X
Medical Physician Assistant
0110002571
VA
363AM0700X
Medical Physician Assistant
102256
NC
363AM0700X
Medical Physician Assistant
C0006682
MD
Other
Enumeration date
08/20/2006
Last updated
01/26/2024
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