=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316944663
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | P. MICHAEL GLOWACKI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2005
-----------------------------------------------------
Last Update Date | 06/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 MALL BLVD STE 102
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-3260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-265-0726
-----------------------------------------------------
Fax | 610-265-3132
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1330 POWELL ST STE 308
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19401-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-622-7371
-----------------------------------------------------
Fax | 484-622-7399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | C1-0003719
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD058394L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------