Provider Demographics
NPI:1821134255
Name:GLASS, IAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:SCOTT
Last Name:GLASS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6780 MAYFIELD RD
Mailing Address - Street 2:ADMIN
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2203
Mailing Address - Country:US
Mailing Address - Phone:440-312-6710
Mailing Address - Fax:440-312-6407
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:ADMIN
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2203
Practice Address - Country:US
Practice Address - Phone:440-312-6710
Practice Address - Fax:440-312-6407
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH44710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine