Provider Demographics
NPI:1376595801
Name:GLASER, PAUL R (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:GLASER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4113 OLEANDER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6821
Mailing Address - Country:US
Mailing Address - Phone:910-791-1300
Mailing Address - Fax:910-791-4125
Practice Address - Street 1:4113 OLEANDER DR
Practice Address - Street 2:SUITE G
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6821
Practice Address - Country:US
Practice Address - Phone:910-791-1300
Practice Address - Fax:910-791-4125
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC116213E00000X
NY2480213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890802RMedicaid
NC0802ROtherBLUECROSS/BLUESHIELD
NC23656OtherMEDCOST
NC1659398OtherOXFORD HEALTH UHC
NC2728879OtherUNITED HEALTHCARE
NYP02480-31OtherNY WORKERS COMP
NC1079890001OtherPALMETTO DURABLE GOODS
NC0802ROtherBLUECROSS/BLUESHIELD
NC1079890001OtherPALMETTO DURABLE GOODS