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Individual

DR. GLENN A. STAYER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-1405
(570) 271-6012
(570) 271-9723
Mailing address
100 N ACADEMY AVE, CREDENTIALS DEPT, DANVILLE, PA 17822-4903
(570) 271-6144

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD038769E
PA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
MD038769E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0011660020001
PA
Enumeration date
05/04/2006
Last updated
08/12/2020
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