Healthcare Provider Details

I. General information

NPI: 1770531386
Provider Name (Legal Business Name): GLENN ANDREW HEALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/07/2023
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 OLD BELGRADE RD
AUGUSTA ME
04330-8058
US

IV. Provider business mailing address

PO BOX 689
BOALSBURG PA
16827-0689
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-9400
  • Fax: 207-621-9402
Mailing address:
  • Phone: 814-237-8627
  • Fax: 814-238-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number015031
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: