Provider Demographics
NPI:1710156518
Name:GLASOW, CHRISTINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:GLASOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1107 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5145
Mailing Address - Country:US
Mailing Address - Phone:469-300-5437
Mailing Address - Fax:469-619-8619
Practice Address - Street 1:1107 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5145
Practice Address - Country:US
Practice Address - Phone:469-300-5437
Practice Address - Fax:469-619-8619
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP66192080P0202X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370765501Medicaid