Provider Demographics
NPI:1184671877
Name:GLAZIER, WAYNE B (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:B
Last Name:GLAZIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:85 PRESCOTT ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2610
Mailing Address - Country:US
Mailing Address - Phone:508-753-7259
Mailing Address - Fax:508-753-9577
Practice Address - Street 1:85 PRESCOTT ST
Practice Address - Street 2:SUITE 403
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2610
Practice Address - Country:US
Practice Address - Phone:508-753-7259
Practice Address - Fax:508-753-9577
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39441208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0176184Medicaid
MA0176184Medicaid
MAN01868Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE