Provider Demographics
NPI:1669459616
Name:GLASER, MARILYN K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:K
Last Name:GLASER
Suffix:
Gender:F
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:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-4049
Mailing Address - Country:US
Mailing Address - Phone:304-645-4043
Mailing Address - Fax:304-645-4713
Practice Address - Street 1:205 ALTA DRIVE
Practice Address - Street 2:
Practice Address - City:ALDERSON
Practice Address - State:WV
Practice Address - Zip Code:24910-0680
Practice Address - Country:US
Practice Address - Phone:304-445-7940
Practice Address - Fax:304-445-2437
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0041987000Medicaid
WV0041987000Medicaid
WVD98017Medicare UPIN