Provider Demographics
NPI:1063443539
Name:GLASS, HOWARD L (DO)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:L
Last Name:GLASS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:2 CHABOT ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4817
Mailing Address - Country:US
Mailing Address - Phone:207-857-9311
Mailing Address - Fax:207-857-9324
Practice Address - Street 1:2 CHABOT ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4817
Practice Address - Country:US
Practice Address - Phone:207-857-9311
Practice Address - Fax:207-857-9324
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1250207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME309980099Medicaid
ME309980099Medicaid
MEB44511Medicare UPIN
MEMM2042Medicare PIN