Provider Demographics
NPI:1528021094
Name:GLASER, THEODORE EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:EDWARD
Last Name:GLASER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-1921
Mailing Address - Street 2:EMERGENCY CARE OF ATLANTA INC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-1921
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:ST JOSEPHS HOSPITAL OF ATLANTA
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1764
Practice Address - Country:US
Practice Address - Phone:404-851-7294
Practice Address - Fax:404-851-7958
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA050168207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA93BBJLMMedicare ID - Type Unspecified
H37328Medicare UPIN