Basic Information
| Provider Information | |||||||||
| NPI: | 1477952190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUARLES | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2331 FRANKLIN RD SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240141111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405106200 | ||||||||
| FaxNumber: | 5408575306 | ||||||||
| Practice Location | |||||||||
| Address1: | 2331 FRANKLIN RD SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405106200 | ||||||||
| FaxNumber: | 5408575306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2014 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 0102205319 | VA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 207R00000X | 0102205319 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.