Provider Demographics
NPI:1205838547
Name:GLASSNER, AMY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:GLASSNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-2000
Mailing Address - Fax:
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3536
Practice Address - Country:US
Practice Address - Phone:419-517-7600
Practice Address - Fax:419-517-7610
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083914208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2498186Medicaid