Provider Demographics
NPI:1467606699
Name:RAZZI, GLORY MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GLORY
Middle Name:MARIE
Last Name:RAZZI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 LANTANA DR
Mailing Address - Street 2:LANTANA SQUARE SHOPPING CENTER
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8807
Mailing Address - Country:US
Mailing Address - Phone:302-234-4000
Mailing Address - Fax:302-234-4315
Practice Address - Street 1:316 LANTANA DR
Practice Address - Street 2:LANTANA SQUARE SHOPPING CENTER
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8807
Practice Address - Country:US
Practice Address - Phone:302-234-4000
Practice Address - Fax:302-234-4315
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000649363A00000X
PAMA053738363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical