Provider Demographics
NPI:1336155589
Name:SPIEGLER, GLENN JAY (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:JAY
Last Name:SPIEGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-1389
Mailing Address - Country:US
Mailing Address - Phone:804-443-4227
Mailing Address - Fax:
Practice Address - Street 1:659 HOSPITAL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560
Practice Address - Country:US
Practice Address - Phone:804-443-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040736207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6404821Medicaid
VA461095OtherBLUE CROSS BLUE SHIELD VA
VAB60152Medicare UPIN
VA00V077R23Medicare ID - Type Unspecified