Provider Demographics
NPI:1205838174
Name:GLUSCIC, JOHN J (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:GLUSCIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1258
Mailing Address - Country:US
Mailing Address - Phone:207-723-5161
Mailing Address - Fax:
Practice Address - Street 1:165 POPLAR ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1235
Practice Address - Country:US
Practice Address - Phone:207-723-2034
Practice Address - Fax:207-723-3006
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD13110207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1205838174Medicaid
ME1205838174Medicaid
ILK37651Medicare PIN