Provider Demographics
NPI:1730679879
Name:GLAIM, RICHARD W
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:GLAIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:W
Other - Last Name:GLAIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCDS
Mailing Address - Street 1:12 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6302
Mailing Address - Country:US
Mailing Address - Phone:518-424-9516
Mailing Address - Fax:
Practice Address - Street 1:12 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6302
Practice Address - Country:US
Practice Address - Phone:518-424-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Single Specialty