Provider Demographics
NPI:1023252426
Name:GLASER, CHRISTIAN CONRAD (DO)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:CONRAD
Last Name:GLASER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29955 THREE NOTCH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-3159
Mailing Address - Country:US
Mailing Address - Phone:301-290-5300
Mailing Address - Fax:
Practice Address - Street 1:29955 THREE NOTCH RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3159
Practice Address - Country:US
Practice Address - Phone:301-290-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0076339207RS0010X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine