Provider Demographics
NPI:1134786171
Name:GLEZERSON, BRYAN ADAM (MD , FRCPC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ADAM
Last Name:GLEZERSON
Suffix:
Gender:M
Credentials:MD , FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104-939 NORTH RIVER RD.
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:K1K3V2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF ANESTHESIOLOGY - BWH
Practice Address - Street 2:75 FRANCIS STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2020-01-27
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-01-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program