Provider Demographics
NPI:1275591505
Name:GLASS, SHARON ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELAINE
Last Name:GLASS
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:PO BOX 52274
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2274
Mailing Address - Country:US
Mailing Address - Phone:865-310-1395
Mailing Address - Fax:865-312-5541
Practice Address - Street 1:1901 CLINCH AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2307
Practice Address - Country:US
Practice Address - Phone:865-310-1395
Practice Address - Fax:865-312-5541
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19822208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3045222Medicaid
3045224Medicare ID - Type Unspecified
E04276Medicare UPIN