Provider Demographics
NPI:1194714931
Name:GLAZER, ALAN USHER (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:USHER
Last Name:GLAZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:U
Other - Last Name:GLAZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:400 BALLYTORE RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2318
Mailing Address - Country:US
Mailing Address - Phone:610-649-0204
Mailing Address - Fax:
Practice Address - Street 1:400 BALLYTORE RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2318
Practice Address - Country:US
Practice Address - Phone:610-649-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034218E208D00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA692901Medicare PIN