Provider Demographics
NPI:1417053968
Name:GLASSON, SANDRA E (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:E
Last Name:GLASSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844560
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-4560
Mailing Address - Country:US
Mailing Address - Phone:757-412-1005
Mailing Address - Fax:757-412-1015
Practice Address - Street 1:968 FIRST COLONIAL RD
Practice Address - Street 2:101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3171
Practice Address - Country:US
Practice Address - Phone:757-412-1005
Practice Address - Fax:757-412-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049731207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6409351Medicaid
VA000001G72Medicare PIN
VA6409351Medicaid
VAF39936Medicare UPIN