Provider Demographics
NPI:1720010226
Name:GLASSIE, LORI (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:GLASSIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 A ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4148
Mailing Address - Country:US
Mailing Address - Phone:510-457-1788
Mailing Address - Fax:510-538-5215
Practice Address - Street 1:1065 A ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4148
Practice Address - Country:US
Practice Address - Phone:925-457-1788
Practice Address - Fax:510-538-5215
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06716ZMedicare PIN
CA0PA161150Medicare ID - Type Unspecified
CA0PA161151Medicare PIN