Provider Demographics
NPI:1912011578
Name:GLAZER, STEVEN LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEWIS
Last Name:GLAZER
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 1:128 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5738
Mailing Address - Country:US
Mailing Address - Phone:203-852-1300
Mailing Address - Fax:203-838-7447
Practice Address - Street 1:128 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5738
Practice Address - Country:US
Practice Address - Phone:203-852-1300
Practice Address - Fax:203-838-7447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G17844Medicare UPIN