Provider Demographics
NPI:1942323118
Name:GLAESER, JANET T
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:T
Last Name:GLAESER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 PEACHTREE LANE S.
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6973
Mailing Address - Country:US
Mailing Address - Phone:440-884-9637
Mailing Address - Fax:
Practice Address - Street 1:5445 PEACHTREE LANE S.
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6973
Practice Address - Country:US
Practice Address - Phone:440-884-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1803892Medicaid