Healthcare Provider Details

I. General information

NPI: 1669459616
Provider Name (Legal Business Name): MARILYN KNOLL GLASER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3076 BIG DRAFT RD
WHITE SULPHUR SPRINGS WV
24986
US

IV. Provider business mailing address

3076 BIG DRAFT RD
WHITE SULPHUR SPRINGS WV
24986
US

V. Phone/Fax

Practice location:
  • Phone: 304-445-7940
  • Fax: 304-445-2437
Mailing address:
  • Phone: 304-445-7940
  • Fax: 304-445-2437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15169
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: