Individual
SAMUEL L GLASS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 MAIN ST, JOHNSTOWN, PA 15901-1507
(814) 536-5343
(814) 536-1525
Mailing address
120 MAIN ST, PO BOX 580, JOHNSTOWN, PA 15901-1507
(814) 536-5343
(814) 536-1525
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
022733E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012572050001
—
PA
Enumeration date
12/07/2005
Last updated
07/08/2007
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