Provider Demographics
NPI:1508856808
Name:GLICKMAN, LAUREN ORLOFF (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ORLOFF
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:MICHELE
Other - Last Name:ORLOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-8135
Mailing Address - Fax:617-724-8010
Practice Address - Street 1:73 HIGH ST
Practice Address - Street 2:CHARLESTOWN HEALTHCARE CENTER
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3026
Practice Address - Country:US
Practice Address - Phone:617-724-8135
Practice Address - Fax:617-724-8010
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA758543OtherTUFTS HEALTH PLAN
MA3166465Medicaid
MAJ17590OtherBCBS MA
G44480Medicare UPIN
MA3166465Medicaid