Provider Demographics
NPI:1912073214
Name:GLASSER, STEPHEN H (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:GLASSER
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 1:2700 QUARRY LAKE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3744
Mailing Address - Country:US
Mailing Address - Phone:410-415-5814
Mailing Address - Fax:410-415-6620
Practice Address - Street 1:2700 QUARRY LAKE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3744
Practice Address - Country:US
Practice Address - Phone:410-415-5814
Practice Address - Fax:410-415-6620
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD35880170Medicaid
MDKS30OtherCAREFIRST
MDT-754OtherFEDERAL BLUE CROSS
MDT-754OtherFEDERAL BLUE CROSS
MD004LMedicare ID - Type UnspecifiedGROUP PROVIDER
MDD76233Medicare UPIN