Provider Demographics
NPI:1043214760
Name:ESCALANTE-GLORSKY, SUSANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:
Last Name:ESCALANTE-GLORSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:ESCALANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 504407
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150
Mailing Address - Country:US
Mailing Address - Phone:816-502-7000
Mailing Address - Fax:
Practice Address - Street 1:801 E. NOLANA AVE
Practice Address - Street 2:STE 4
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6113
Practice Address - Country:US
Practice Address - Phone:956-686-2626
Practice Address - Fax:956-686-1616
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1029174400000X
MO2015019922207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE68888Medicare UPIN