Provider Demographics
NPI:1659350734
Name:GLICKMAN, PETER LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:LOUIS
Last Name:GLICKMAN
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 1:450 E 20TH ST
Mailing Address - Street 2:APT 8H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8238
Mailing Address - Country:US
Mailing Address - Phone:646-244-7856
Mailing Address - Fax:
Practice Address - Street 1:61 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1817
Practice Address - Country:US
Practice Address - Phone:212-772-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4260752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA231955165OtherINTERGROUP SERVICES
OH2855227Medicaid
PAMD426075OtherHEALTH PARTNERS
AKMD001PAMedicaid
PA101234464Medicaid
LA1600156Medicaid
IA1659350734Medicaid
PA231955165OtherAETNA
PA2393615000OtherKHPE
NY03241196Medicaid
PAP00229796OtherRAILROAD MEDICARE
FL054764600Medicaid
PA1725277OtherHIGHMARK BLUE SHIELD
PA2393615000OtherIBC
PA30020753OtherKEYSTONE MERCY
PA9336768OtherPHCS
PAPA7584OtherHEALTHNET
PA101234464OtherAMERICHOICE OF PA
ID808352700Medicaid
OK200262380AMedicaid
PAP00229796OtherRAILROAD MEDICARE
PA9336768OtherPHCS
ID808352700Medicaid
PA101234464OtherAMERICHOICE OF PA
PAPA7584OtherHEALTHNET