Provider Demographics
NPI:1285972851
Name:MICHAEL GLASSER, MD,LLC
Entity type:Organization
Organization Name:MICHAEL GLASSER, MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-299-7340
Mailing Address - Street 1:4405 EAST WEST HIGHWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4405 EAST WEST HIGHWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4534
Practice Address - Country:US
Practice Address - Phone:301-983-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00268102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152511500Medicaid
DC274261YPOCMedicare PIN