Provider Demographics
NPI:1891945051
Name:GLASS, JASON DOUGLAS (ACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DOUGLAS
Last Name:GLASS
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Gender:M
Credentials:ACNP-BC
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Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:SW460
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-2462
Mailing Address - Fax:617-632-4448
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:SW460
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-2462
Practice Address - Fax:617-632-4448
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2011-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA273839363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care