Provider Demographics
NPI:1619399961
Name:PAUL GLAZER, MD, LLC
Entity Type:Organization
Organization Name:PAUL GLAZER, MD, LLC
Other - Org Name:PAUL GLAZER, MD, PCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-667-2288
Mailing Address - Street 1:545 HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1703
Mailing Address - Country:US
Mailing Address - Phone:617-667-2288
Mailing Address - Fax:617-667-2233
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-2288
Practice Address - Fax:617-667-2233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL GLAZER, MD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-06
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3157717Medicaid
MA3157717Medicaid