Provider Demographics
NPI:1407961469
Name:GLIDDEN, RANDALL S (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:S
Last Name:GLIDDEN
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:BETH ISRAEL DEACONESS
Mailing Address - Street 2:330 BROOKLIE AVE-STE 308
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-3112
Mailing Address - Fax:
Practice Address - Street 1:BETH ISRAEL DEACONESS
Practice Address - Street 2:330 BROOKLINE AVE. STE 308
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41582207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology