Provider Demographics
NPI:1073319554
Name:GLATT MEDICAL A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:GLATT MEDICAL A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-552-8100
Mailing Address - Street 1:1860 EL CAMINO REAL STE 301
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3114
Mailing Address - Country:US
Mailing Address - Phone:650-552-8100
Mailing Address - Fax:
Practice Address - Street 1:1860 EL CAMINO REAL STE 301
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3114
Practice Address - Country:US
Practice Address - Phone:650-552-8100
Practice Address - Fax:650-552-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty