Provider Demographics
NPI:1609975754
Name:GLASER, WARREN (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:GLASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BRISTOL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-4224
Mailing Address - Country:US
Mailing Address - Phone:585-381-8180
Mailing Address - Fax:
Practice Address - Street 1:417 SOUTH AVE
Practice Address - Street 2:SAINT JOSEPH'S NEIGHBORHOOD CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1009
Practice Address - Country:US
Practice Address - Phone:585-325-5260
Practice Address - Fax:585-325-3017
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073623-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0048330Medicaid
NY0048330Medicaid
D74863Medicare UPIN