Provider Demographics
NPI:1578721049
Name:PADRON GLEICH, MARIANN C (MD)
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:C
Last Name:PADRON GLEICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIANN
Other - Middle Name:COROMOTO
Other - Last Name:PADRON GLEICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 ERDMAN WAY
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-466-7800
Mailing Address - Fax:978-466-9333
Practice Address - Street 1:105 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-7800
Practice Address - Fax:978-466-9333
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241784207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400241559Medicare PIN