Individual
DR. GLEN CARLBERG JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD039684L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010990080001
—
PA
05
—
01040784
—
NY
01
—
050075791
RR MEDICARE PIN
PA
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039832
MEDICARE GROUP
PA
Enumeration date
03/15/2006
Last updated
03/10/2021
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