Provider Demographics
NPI:1093708778
Name:GLAVAS, IOANNIS P (MD)
Entity Type:Individual
Prefix:
First Name:IOANNIS
Middle Name:P
Last Name:GLAVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NEWBURY ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2935
Mailing Address - Country:US
Mailing Address - Phone:617-725-1921
Mailing Address - Fax:866-365-1847
Practice Address - Street 1:115 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2935
Practice Address - Country:US
Practice Address - Phone:617-725-1921
Practice Address - Fax:866-365-1847
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207834207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3561734OtherAETNA/US HEALTHCARE
MAAA16977OtherHARVARD PILGRIM
MAJ27979OtherBC/BS
MA469615OtherTUFTS HEALTH
CE5062OtherRAILROAD MEDICARE
MA0033970OtherNHP NEIGHBORHOOD HEALTH
MA0801592OtherUNITED HEALTHCARE
MA2071045Medicaid
MA469615OtherTUFTS HEALTH
MA469615OtherTUFTS HEALTH