Provider Demographics
NPI:1699883736
Name:GLASMAN, ANN (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:GLASMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3072
Mailing Address - Country:US
Mailing Address - Phone:781-961-1330
Mailing Address - Fax:781-963-8493
Practice Address - Street 1:999 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3072
Practice Address - Country:US
Practice Address - Phone:781-961-1330
Practice Address - Fax:781-963-8493
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0164500Medicaid
MAA33827Medicare ID - Type Unspecified
MA0164500Medicaid