Provider Demographics
NPI:1962455337
Name:GLASSY, ERIC F (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:F
Last Name:GLASSY
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 1:2374 E PACIFICA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6214
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7054
Practice Address - Street 1:2374 E PACIFICA PL
Practice Address - Street 2:
Practice Address - City:RANCHO DOMINGUEZ
Practice Address - State:CA
Practice Address - Zip Code:90220-6214
Practice Address - Country:US
Practice Address - Phone:310-225-3244
Practice Address - Fax:310-698-7054
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36186207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301095520OtherMEDICAL LICENSE
CA00G361860Medicaid
IN01067536AOtherMEDICAL LICENSE
NV13541OtherMEDICAL LICENSE
OH35.095409OtherMEDICAL LICENSE
CAG36186OtherMEDICAL LICENSE
CAA46603Medicare UPIN
IN01067536AOtherMEDICAL LICENSE