Provider Demographics
NPI:1134423213
Name:DEBORAH A. GLAZER, MD
Entity type:Organization
Organization Name:DEBORAH A. GLAZER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-448-5886
Mailing Address - Street 1:127 MASCOMA ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2647
Mailing Address - Country:US
Mailing Address - Phone:603-448-5886
Mailing Address - Fax:603-448-3723
Practice Address - Street 1:127 MASCOMA ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2647
Practice Address - Country:US
Practice Address - Phone:603-448-5886
Practice Address - Fax:603-448-3723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009660Medicaid
VT1001474Medicaid
NH9660Medicare PIN
VT1001474Medicaid