Provider Demographics
NPI:1629083365
Name:GLEZEN, SHARON J (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:J
Last Name:GLEZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 CRITTENDEN BLVD
Mailing Address - Street 2:BOX 617
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8617
Mailing Address - Country:US
Mailing Address - Phone:585-275-2662
Mailing Address - Fax:585-276-0149
Practice Address - Street 1:250 CRITTENDEN BLVD
Practice Address - Street 2:BOX 617
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8617
Practice Address - Country:US
Practice Address - Phone:585-275-2662
Practice Address - Fax:585-276-0149
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY178405-7207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01485818Medicaid
NYE62118Medicare UPIN
NY01485818Medicaid
NY17968GMedicare ID - Type Unspecified