Provider Demographics
NPI:1063412344
Name:MISKOVSKY, GLENN E (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:E
Last Name:MISKOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:31 HALL DR
Mailing Address - Street 2:AMHERST MEDICAL CENTER
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2751
Mailing Address - Country:US
Mailing Address - Phone:413-256-8561
Mailing Address - Fax:413-256-4421
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:AMHERST MEDICAL CENTER
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:413-256-4421
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA207711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0115720Medicaid
MAJ23077OtherBLUE CROSS & BLUE SHIELD
MAJ23077OtherBLUE CROSS & BLUE SHIELD
MAA31756Medicare ID - Type Unspecified