Provider Demographics
NPI:1770807281
Name:DR. LEONARD C. GLASER, M.D.P.C.
Entity type:Organization
Organization Name:DR. LEONARD C. GLASER, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-621-8361
Mailing Address - Street 1:360 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2503
Mailing Address - Country:US
Mailing Address - Phone:860-621-8361
Mailing Address - Fax:860-621-6275
Practice Address - Street 1:360 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2503
Practice Address - Country:US
Practice Address - Phone:860-621-8361
Practice Address - Fax:860-621-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1220037Medicaid
CTDO2760Medicare UPIN
CT1194752089Medicare PIN