Provider Demographics
NPI:1194752089
Name:GLASER, LEONARD CHARLES JR (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:CHARLES
Last Name:GLASER
Suffix:JR
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:PO BOX 11390
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:239-348-4221
Mailing Address - Fax:
Practice Address - Street 1:8340 COLLIER BLVD STE 405
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114
Practice Address - Country:US
Practice Address - Phone:239-348-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022003207R00000X
FLME139291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103666800Medicaid
CT1220037Medicaid
CT2V0711OtherHEALTH NET
CT4002857OtherAETNA
CT050632OtherCONNCARE
CT110217801OtherRR MEDICARE
CTHAP004OtherOXFORD
CT2V0711OtherHEALTH NET