Provider Demographics
NPI:1851480388
Name:GLASS HEALTH SYSTEMS, LLC
Entity type:Organization
Organization Name:GLASS HEALTH SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-2700
Mailing Address - Street 1:401 EAST CORPORATE DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6431
Mailing Address - Country:US
Mailing Address - Phone:214-379-3314
Mailing Address - Fax:214-379-3322
Practice Address - Street 1:3635 OLD COURT ROAD
Practice Address - Street 2:SUITE 405
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-484-2700
Practice Address - Fax:410-484-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD310700100Medicaid
D77704Medicare UPIN
S062V375Medicare ID - Type Unspecified