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General NPI Number Information
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NPI Number | 1477952190
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Entity Type | Individual
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Provider Name | GLENN RICHARD QUARLES JR. D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 2331 FRANKLIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24014
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Country | US
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Telephone | 540-510-6200
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Fax | 540-857-5306
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Provider Business Mailing Address
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Address Line | 2331 FRANKLIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24014-1111
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Country | US
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Telephone | 540-510-6200
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Fax | 540-857-5306
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0102205319
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0102205319
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License Number State | VA
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