Provider Demographics
NPI:1346261187
Name:GLANCE, LAURENT G (MD)
Entity Type:Individual
Prefix:
First Name:LAURENT
Middle Name:G
Last Name:GLANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 604
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5982
Mailing Address - Fax:585-756-0169
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 604
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5982
Practice Address - Fax:585-756-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY168907207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000912182001OtherBS WNY/HEALTHNOW
NY058141OtherMVP PROV#
NY00040422801OtherUNIVERA
NY5399012OtherGHI
NY01039096Medicaid
NY4203441OtherAETNA
NY050074307OtherRAILROAD MEDICARE
NYMDE041OtherPREFERRED CARE
NY2222OtherBLUE SHIELD GROUP#
NYG0189393590OtherBLUE CHOICE GROUP#
NYP010168907OtherBLUE CHOICE PROV#