MEDICARE: LISA ILANA GLASSER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	60322125	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407858111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ILANA GLASSER MD

Provider Business Mailing Address
First Line	:	7683 SE 27TH ST
Second Line	:	#310
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2804
Country	:	US
Telephone Number	:	206-941-9306
Fax Number	:

Provider Business Practice Location Address
First Line	:	7683 SE 27TH ST
Second Line	:	#310
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2804
Country	:	US
Telephone Number	:	206-941-9306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/12/2013

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