Provider Demographics
| NPI: | 1659323699 |
|---|---|
| Name: | GLASS, HARRY (DO) |
| Entity type: | Individual |
| Prefix: | |
| First Name: | HARRY |
| Middle Name: | |
| Last Name: | GLASS |
| Suffix: | |
| Gender: | M |
| Credentials: | DO |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 207 OCEAN RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | OCEAN CITY |
| Mailing Address - State: | NJ |
| Mailing Address - Zip Code: | 08226-4548 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 609-706-1935 |
| Mailing Address - Fax: | 609-710-9591 |
| Practice Address - Street 1: | 207 OCEAN RD STE 510 |
| Practice Address - Street 2: | |
| Practice Address - City: | OCEAN CITY |
| Practice Address - State: | NJ |
| Practice Address - Zip Code: | 08226-4548 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 609-706-1935 |
| Practice Address - Fax: | 609-710-0501 |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2006-05-17 |
| Last Update Date: | 2021-12-17 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| PA | OS-002704L | 207LP2900X |
| NJ | 25MB02315400 | 207LA0401X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 207LA0401X | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 0022342000 | Other | KEYSTONE HEALTH PLAN EAST |
| PA | 22-1994560 | Other | GREAT WEST HEALTHCARE |
| NJ | 23-2919275 | Other | HORIZON BLUE CROSS BLUE SHIELD |
| PA | 23-2919275 | Other | GREAT WEST HEALTHCARE |
| PA | 33028C | Other | HORIZON MERCY |
| PA | 8194307 | Other | CIGNA |
| NJ | 1169961 | Other | AETNA |
| PA | 33029C | Other | HORIZON MERCY |
| PA | 50085446 | Other | CAPITAL BLUE CROSS |
| PA | 000640054 | Medicaid | |
| NJ | 22-1994560 | Other | HORIZON BLUE CROSS BLUE SHIELD |
| PA | 23-2919275 | Other | DEVON |
| PA | 22-1994560 | Other | DEVON |
| PA | 22-1994560 | Other | PROCURA MANAGEMENT, INC. |
| NJ | 22-1994560 | Other | UNITED HEALTHCARE/OXFORD |
| PA | 22-1994560 | Other | FIRST MCO |
| NJ | 1201409 | Other | AETNA |
| PA | 1659323699 | Other | BRAVO HEALTH |
| PA | 22-1994560 | Other | HEALTH AMERICA/HEALTH ASSURANCE |
| PA | 23-2919275 | Other | FIRST MCO |
| PA | 23-2919275 | Other | PROCURA MANAGEMENT, INC |
| NJ | 23-2919275 | Other | FIRST MCO |
| PA | 2551644 | Other | AETNA |
| PA | 136736 | Other | PA BLUE SHIELD |
| PA | 22-1994560 | Other | QUALCARE |
| PA | 22-1994560 | Other | UNITED HEALTHCARE/OXFORD |
| PA | 136736 | Other | PERSONAL CHOICE |
| PA | 1659993 | Other | CIGNA |
| PA | 2189116 | Other | AETNA |
| NJ | 22-1994560 | Other | FIRST MCO |
| PA | 23-2919275 | Other | UNITED HEALTHCARE/OXFORD |
| PA | 23-2919275 | Other | HEALTH AMERICA/HEALTH ASSURANCE |
| PA | 23-2919275 | Other | QUALCARE |
| PA | 0022342000 | Other | AMERIHEALTH |
| NJ | 23-2919275 | Other | UNITED HEALTHCARE/OXFORD |
| PA | 5738424 | Other | FIRST HEALTH NETWORK |
| PA | P00084114 | Other | RAILROAD MEDICARE |
| PA | 22-1994560 | Other | FIRST MCO |
| PA | 22-1994560 | Other | HEALTH AMERICA/HEALTH ASSURANCE |
| NJ | 22-1994560 | Other | UNITED HEALTHCARE/OXFORD |
| PA | 136736 | Medicare ID - Type Unspecified | PA MEDICARE |
| PA | 000640054 | Medicaid | |
| NJ | 536678RVB | Medicare PIN | |
| PA | 23-2919275 | Other | GREAT WEST HEALTHCARE |
| PA | 33028C | Other | HORIZON MERCY |
