Provider Demographics
NPI:1275559007
Name:LAWSON, GLASINE O (MD)
Entity Type:Individual
Prefix:
First Name:GLASINE
Middle Name:O
Last Name:LAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LYON PL
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-2590
Mailing Address - Country:US
Mailing Address - Phone:315-394-7542
Mailing Address - Fax:315-394-0015
Practice Address - Street 1:3 LYON PL
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-2590
Practice Address - Country:US
Practice Address - Phone:315-713-6700
Practice Address - Fax:315-713-6711
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428726207V00000X
NY278033207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04373084Medicaid
OH2662122Medicaid
PA1015678190001Medicaid
PA1015678190001Medicaid
PA113673WXHMedicare PIN