Provider Demographics
NPI:1841207016
Name:GLICK, PHILIP L (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:GLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8000 DEPT 313
Mailing Address - Street 2:UNIVERSITY AT BUFFALO SURGEONS, INC.
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-888-4889
Mailing Address - Fax:716-849-5620
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-3371
Practice Address - Fax:716-859-4580
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1752022086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01084179Medicaid
RA7061Medicare ID - Type Unspecified
A49065Medicare UPIN