Provider Demographics
NPI:1306824941
Name:GLAZIER, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:GLAZIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2129
Mailing Address - Country:US
Mailing Address - Phone:978-287-9400
Mailing Address - Fax:978-287-9408
Practice Address - Street 1:330 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2129
Practice Address - Country:US
Practice Address - Phone:978-287-9400
Practice Address - Fax:978-287-9408
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214462208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1205718OtherUNITED HEALTH CARE
MA8474953OtherCIGNA
MAJ26456OtherBLUE CROSS
MA214462OtherTUFTS
MA206534OtherHARVARD PILGRIM
MA2003074Medicaid
MA0007595463OtherAETNA
MA206534OtherHARVARD PILGRIM
MAA35088Medicare ID - Type Unspecified