Provider Demographics
NPI:1184781742
Name:GLASER, ALAN I (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:I
Last Name:GLASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:65 WALNUT ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-431-2345
Mailing Address - Fax:781-239-9966
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-431-2345
Practice Address - Fax:781-239-9966
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA151413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3163288Medicaid
MAA22177Medicare ID - Type Unspecified
MA3163288Medicaid