Provider Demographics
NPI:1699791822
Name:GLAIBERMAN, CRAIG BRYCE (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:BRYCE
Last Name:GLAIBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:#3100 - ACC
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-3606
Mailing Address - Fax:916-734-8490
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:#3100 - ACC
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-3606
Practice Address - Fax:916-734-8490
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030049952085R0202X, 2085R0204X
CAA1031352085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208973602Medicaid
H88922Medicare UPIN