Provider Demographics
NPI:1689671828
Name:GLASER, ANNE MIRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MIRIAM
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 1:9001 DAYTON WAY UNIT C
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1638
Mailing Address - Country:US
Mailing Address - Phone:424-355-0046
Mailing Address - Fax:
Practice Address - Street 1:9001 DAYTON WAY UNIT C
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1638
Practice Address - Country:US
Practice Address - Phone:424-355-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA084211002085R0202X, 207U00000X
PAMD4301842085R0202X, 2085R0202X
CAG568262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100044020Medicaid
NY02979495Medicaid
CACB288879OtherMEDICARE
P00623749OtherMEDICARE RR