Provider Demographics
NPI:1154356319
Name:GLASS, CONSTANCE I (MD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:I
Last Name:GLASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:12 ST PAUL DR STE 207
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1035
Practice Address - Country:US
Practice Address - Phone:717-217-6882
Practice Address - Fax:717-217-6883
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA060823L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00377943OtherRAILROAD MEDICARE
PA186915OtherUNISON
PA25-1716306OtherHEALTHNET/TRICARE
PA440475OtherHEALTH AMERICA
PA001643490 0004Medicaid
PA2144237OtherMAMSI
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA867633OtherMEDICARE GROUP #
PA1360663OtherAETNA HMO
PA25-1716306OtherINTERGROUP
PA25-1716306OtherINFORMED
PA25-1716306OtherFIRST HEALTH
PA5409494OtherAETNA NON-HMO
PA907136OtherHIGHMARK BLUE SHIELD
PAMD060823LOtherLICENSE
PA120420413OtherDEPT OF LABOR
PA50060634OtherCAPITAL BLUECROSS
PA1557277OtherGATEWAY
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherDEVON
PAG920-0061/KV77CUOtherCAREFIRST
PAG920-0061/KV77CUOtherCAREFIRST
PA907136OtherHIGHMARK BLUE SHIELD
PAG02432Medicare UPIN