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General NPI Number Information
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NPI Number | 1609937663
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Entity Type | Individual
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Provider Name | GLENN JOSEPH KASHURBA MD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 113 S CENTER AVE
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City | SOMERSET
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State | PA
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Zip | 15501-2057
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Country | US
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Telephone | 814-445-9695
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Fax | 814-444-8812
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Provider Business Mailing Address
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Address Line | 113 S CENTER AVE STE 1
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City | SOMERSET
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State | PA
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Zip | 15501-2063
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Country | US
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Telephone | 814-445-9695
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Fax | 814-444-8812
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD029895E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | D0035419
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License Number State | MD
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