Provider Demographics
NPI:1346290632
Name:GLICKSMAN, CHARLOTTE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:
Last Name:GLICKSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:STEINBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-9193
Practice Address - Fax:410-601-8977
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47128208000000X, 2080P0202X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD370007799OtherR/R MEDICARE PROVIDER #
MD784400000Medicaid
MD784400000Medicaid
MD370007799OtherR/R MEDICARE PROVIDER #