Provider Demographics
NPI:1982648507
Name:GLINER, BORIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:GLINER
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 1:1440 ROCKSIDE ROAD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2774
Mailing Address - Country:US
Mailing Address - Phone:216-661-1123
Mailing Address - Fax:216-661-4445
Practice Address - Street 1:1440 ROCKSIDE ROAD
Practice Address - Street 2:SUITE 215
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2774
Practice Address - Country:US
Practice Address - Phone:216-661-1123
Practice Address - Fax:216-661-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053630207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0642951Medicaid
OHGL0590282Medicare ID - Type UnspecifiedMEDICARE
OH0642951Medicaid