Provider Demographics
NPI:1568550341
Name:GLASER, LAURA M (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:GLASER
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:PO BOX 7291
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:15 GRACELAWN RD STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210
Practice Address - Country:US
Practice Address - Phone:207-333-4710
Practice Address - Fax:207-333-4715
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA724363AM0700X, 363AS0400X
MEPA-724363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098680OtherANTHEM
MEP37889Medicare UPIN
GLA1517Medicare ID - Type Unspecified
NH30334661Medicaid
LA320080099Medicaid