Active NPI
Jerry Glenn, M.D., PH.D.
- Surgery Physician
- State College, PA
National Provider Identifier
1750345229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD030666E
- Practice address
- 3901 S Atherton St
Suite 2
State College, PA 16801-8324 - Phone
- (814) 466-2300
- Fax
- (814) 466-2822
- NPI assigned
- Apr 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Oncology Physician | 2086X0206X | MD030666E | PA | |
| Surgery Physician | 208600000X | MD030666E | PA | Primary |
Addresses
Primary practice location
3901 S Atherton St
Suite 2
State College, PA 16801-8324
Mailing address
3901 S Atherton St
Suite 2
State College, PA 16801-8324
Phone (814) 466-2300
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30477 | Other | PA | GEISINGER HEALTH PLAN |
| 50047400 | Other | PA | CAPITAL BLUE CROSS |
| 0009667720004 | Medicaid | PA | |
| GL116265 | Other | PA | HIGHMARK BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1750345229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3901 S ATHERTON ST",
"address_2": "SUITE 2",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168018324",
"telephone_number": "814-466-2300",
"fax_number": "814-466-2822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 S ATHERTON ST",
"address_2": "SUITE 2",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168018324",
"telephone_number": "814-466-2300",
"fax_number": "814-466-2822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "JERRY",
"credential": "M.D., PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-13",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "2086X0206X",
"taxonomy_group": "",
"desc": "Surgery, Surgical Oncology",
"state": "PA",
"license": "MD030666E",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MD030666E",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEISINGER HEALTH PLAN",
"identifier": "30477",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50047400",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0009667720004",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "GL116265",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.