Provider Demographics
NPI:1760569396
Name:GLASEROFF, ALAN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MARTIN
Last Name:GLASEROFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 H ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5837
Mailing Address - Country:US
Mailing Address - Phone:707-822-7041
Mailing Address - Fax:708-822-0655
Practice Address - Street 1:1318 H ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5837
Practice Address - Country:US
Practice Address - Phone:707-822-7041
Practice Address - Fax:708-822-0655
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G408660Medicaid
CAG40866OtherMEDICAL LICENSE
CA00G408660Medicaid
CAG40866OtherMEDICAL LICENSE