Provider Demographics
NPI:1285764852
Name:GLASSMAN, RICHARD IRA (DO)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:IRA
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 POTOMAC CIR
Mailing Address - Street 2:UNIT 295
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6750
Mailing Address - Country:US
Mailing Address - Phone:303-340-3360
Mailing Address - Fax:303-366-7370
Practice Address - Street 1:830 POTOMAC CIR
Practice Address - Street 2:UNIT 295
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6750
Practice Address - Country:US
Practice Address - Phone:303-340-3360
Practice Address - Fax:303-366-7370
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01193994Medicaid
COD84521Medicare UPIN
COC4322Medicare ID - Type Unspecified