Healthcare Provider Details

I. General information

NPI: 1083547749
Provider Name (Legal Business Name): ERIC DANIEL GLASS JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 N RIVER ST
WILKES BARRE PA
18764-0999
US

IV. Provider business mailing address

6 GEORGE ST FL 2
PITTSTON PA
18640-1904
US

V. Phone/Fax

Practice location:
  • Phone: 570-829-8111
  • Fax:
Mailing address:
  • Phone: 717-870-0571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA007881
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: