Provider Demographics
NPI:1104989482
Name:GLICK, RICHARD SAUL (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SAUL
Last Name:GLICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 CANDLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1023
Mailing Address - Country:US
Mailing Address - Phone:215-635-0333
Mailing Address - Fax:
Practice Address - Street 1:1444 CANDLEBROOK DR
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1023
Practice Address - Country:US
Practice Address - Phone:215-635-0333
Practice Address - Fax:215-885-1721
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002648L207VG0400X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0045371000OtherHMO ID
PA000090349OtherHIGHMARK BLUE SHIELD ID
PAC29526Medicare UPIN