Provider Demographics
NPI:1356397574
Name:GLAZERMAN, LARRY R (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:R
Last Name:GLAZERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N SHIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-2228
Mailing Address - Country:US
Mailing Address - Phone:302-655-7296
Mailing Address - Fax:302-655-1907
Practice Address - Street 1:625 N SHIPLEY ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2228
Practice Address - Country:US
Practice Address - Phone:302-655-7296
Practice Address - Fax:302-655-1907
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019651E207V00000X
FLME102634207V00000X
DEC1-0011359207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037452OtherHIGHMARK BLUE SHIELD
PA0735550Medicaid
PA160047167OtherRAILROAD MEDICARE
FL64329OtherBLUE CROSS BLUE SHIELD
FL000326900Medicaid
PA037452OtherKEYSTONE CENTRAL
PA4265977OtherAETNA PPO
PA037452OtherKEYSTONE CENTRAL
PA0735550Medicaid