Provider Demographics
NPI:1083688824
Name:GLASS, WILLIAM FREDRICK II (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDRICK
Last Name:GLASS
Suffix:II
Gender:M
Credentials:MD, PHD
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 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0816
Practice Address - Country:US
Practice Address - Phone:888-882-3990
Practice Address - Fax:434-243-6499
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048070207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA330785OtherANTHEM BC/BS
NC890648XMedicaid
VAPAROtherCORVEL CORCARE
VA004910681Medicaid
NC0648XOtherBC/BS NC
VAPAROtherCIGNA
VA99061OtherSENTARA OHP/SHP
VAPAROtherAMERICAS HEALTH PLAN
VAPAROtherMID-ATLANTIC VICARE
VAPAROtherUSA MANAGE D CARE
VAPAROtherVA PREMIER VPH
VA-008OtherCHAMPUS/TRICARE
VA239722OtherUHC/MAMSI/MDIPA
VAPAROtherMULTI PLAN
VAPAROtherAETNA PPO
VAPAROtherFIRST HEALTH
VAPAROtherUSA MANAGE D CARE
VAE91623Medicare UPIN
NC890648XMedicaid