Provider Demographics
NPI:1316944663
Name:GLOWACKI, P. MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:P.
Middle Name:MICHAEL
Last Name:GLOWACKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 POWELL ST
Mailing Address - Street 2:STE 308
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3350
Mailing Address - Country:US
Mailing Address - Phone:484-622-7371
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:210 MALL BLVD
Practice Address - Street 2:STE 102
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3260
Practice Address - Country:US
Practice Address - Phone:610-265-0726
Practice Address - Fax:610-265-3132
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0003719207Q00000X
PAMD058394L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherTPI GROUP MEDICARE ID
PA1007278000OtherTPI GROUP MA
PACD4829OtherTPI GROUP RR MEDICARE
DE0000379801Medicaid
PA1007278000OtherTPI GROUP MA
DEF20708Medicare UPIN