Provider Demographics
NPI:1902826654
Name:GLAZER, DONALD JAY (DPM)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAY
Last Name:GLAZER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 E PARHAM RD
Mailing Address - Street 2:MOB III SUITE 318
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4371
Mailing Address - Country:US
Mailing Address - Phone:804-741-2889
Mailing Address - Fax:804-750-1546
Practice Address - Street 1:7702 E PARHAM RD STE 318
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4374
Practice Address - Country:US
Practice Address - Phone:804-741-2889
Practice Address - Fax:804-750-1546
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000433213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9332243Medicaid
VA480012573Medicare PIN
VAT21882Medicare UPIN
VA0733810001Medicare NSC
VA9332243Medicaid