Provider Demographics
NPI:1114415437
Name:GLOSCHAT, TYLER (DPM)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:GLOSCHAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 LORTON STATION BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4798
Mailing Address - Country:US
Mailing Address - Phone:571-418-8670
Mailing Address - Fax:
Practice Address - Street 1:9010 LORTON STATION BLVD STE 270
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4798
Practice Address - Country:US
Practice Address - Phone:571-418-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000880213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery