Provider Demographics
NPI:1447419015
Name:GLASS, PAUL EDWIN III (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWIN
Last Name:GLASS
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:69 CHURCH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2540
Mailing Address - Country:US
Mailing Address - Phone:413-551-7609
Mailing Address - Fax:413-570-7242
Practice Address - Street 1:69 CHURCH ST STE 6
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2540
Practice Address - Country:US
Practice Address - Phone:413-551-7609
Practice Address - Fax:413-570-7242
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2022-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2613522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811431943OtherGROUP NPI