Provider Demographics
NPI:1205021706
Name:GLAZIER, JOANN COBB (CERTIFIED MASTO FIT)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:COBB
Last Name:GLAZIER
Suffix:
Gender:F
Credentials:CERTIFIED MASTO FIT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2200 BOULEVARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2305
Mailing Address - Country:US
Mailing Address - Phone:804-520-0484
Mailing Address - Fax:804-520-0729
Practice Address - Street 1:2200 BOULEVARD
Practice Address - Street 2:SUITE B
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2305
Practice Address - Country:US
Practice Address - Phone:804-520-0484
Practice Address - Fax:804-520-0729
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-09
Last Update Date:2007-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA039541384392332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0738290001Medicare PIN