Individual
MR. GLENN W RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6252 MAHONING AVENUE, AUSTINTOWN, OH 44515
(330) 792-7418
(330) 792-9092
Mailing address
4250 OAK KNOLL DR, YOUNGSTOWN, OH 44512-1409
(330) 720-3748
(330) 330-8284
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
18356
WI
207P00000X
Emergency Medicine Physician
29480
WV
207P00000X
Emergency Medicine Physician
57154
KY
207P00000X
Emergency Medicine Physician
Primary
57174
KY
207Q00000X
Family Medicine Physician
35.075137
OH
207R00000X
Internal Medicine Physician
57174
KY
208M00000X
Hospitalist Physician
57174
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000038430
ANTHEM
OH
01
—
000000349348
ANTHEM
OH
01
—
101308100-0001
PENNSYLVANIA MEDICAID
OH
01
—
101308100-0002
PENNSYLVANIA MEDICAID
OH
05
—
2223338
—
OH
Enumeration date
12/16/2005
Last updated
12/20/2023
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