MEDICARE: WILLIAM J GLASSMIRE PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	OA000251L	PA

General Provider Information

NPI Number	:	1154329944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J GLASSMIRE PAC

Provider Business Mailing Address
First Line	:	7515 STENTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3710
Country	:	US
Telephone Number	:	267-335-5264
Fax Number	:	267-335-5273

Provider Business Practice Location Address
First Line	:	6122 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-3718
Country	:	US
Telephone Number	:	215-338-6677
Fax Number	:	215-338-9935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	12/19/2018

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