Provider Demographics
NPI:1396746293
Name:GLASSNER, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:GLASSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:324 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7150
Mailing Address - Country:US
Mailing Address - Phone:302-396-2751
Mailing Address - Fax:302-396-9077
Practice Address - Street 1:324 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7150
Practice Address - Country:US
Practice Address - Phone:302-369-2751
Practice Address - Fax:302-396-9077
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC10002162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01349M01Medicare PIN
DEB66486Medicare UPIN