Provider Demographics
NPI:1982373551
Name:GLAZER, CHARLES BRIAN
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRIAN
Last Name:GLAZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 FALLEN BROOK LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-7032
Mailing Address - Country:US
Mailing Address - Phone:216-870-0157
Mailing Address - Fax:
Practice Address - Street 1:3213 FALLEN BROOK LN
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-7032
Practice Address - Country:US
Practice Address - Phone:216-870-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No376J00000XNursing Service Related ProvidersHomemaker