Provider Demographics
NPI:1316914237
Name:GLASSMAN, ALAN DANIEL (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:DANIEL
Last Name:GLASSMAN
Suffix:
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 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO 2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-206-1800
Mailing Address - Fax:513-208-1834
Practice Address - Street 1:5885 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1691
Practice Address - Country:US
Practice Address - Phone:513-206-1800
Practice Address - Fax:513-206-1834
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054446207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2520462OtherUNITED
KY64860687Medicaid
0646138OtherAETNA
TXP8B127710Medicaid
000000238164OtherANTHEM WILIMINGTON
OH0654082Medicaid
IN100317750Medicaid
IN000000279060OtherANTHEM DEARBORN
000000019843OtherANTHEM HAMILTON
311438871053OtherCARESOURCE
283816OtherAMERIGROUP
54446OtherHUMANA CHOICECARE
TXP8B127710Medicaid
IN100317750Medicaid
OH4088076Medicare PIN