Individual
JERRY GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
3901 S ATHERTON ST, SUITE 2, STATE COLLEGE, PA 16801-8324
(814) 466-2300
(814) 466-2822
Mailing address
3901 S ATHERTON ST, SUITE 2, STATE COLLEGE, PA 16801-8324
(814) 466-2300
(814) 466-2822
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD030666E
PA
2086X0206X
Surgical Oncology Physician
MD030666E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009667720004
—
PA
01
—
30477
GEISINGER HEALTH PLAN
PA
01
—
50047400
CAPITAL BLUE CROSS
PA
01
—
GL116265
HIGHMARK BLUE SHIELD
PA
Enumeration date
04/13/2006
Last updated
09/11/2025
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