MEDICARE: DR. GLEN ANDREW WASKIN DO

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	207Q00000X	Family Medicine Physician	OS 8048	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427167204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN ANDREW WASKIN DO

Provider Business Mailing Address
First Line	:	2701 NE 14TH STREET CSWY
Second Line	:	SUITE 5
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3535
Country	:	US
Telephone Number	:	954-545-1560
Fax Number	:	954-545-1561

Provider Business Practice Location Address
First Line	:	2701 NE 14TH STREET CSWY
Second Line	:	SUITE 5
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3535
Country	:	US
Telephone Number	:	954-545-1560
Fax Number	:	954-545-1561

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/04/2012

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Directions to “ DR. GLEN ANDREW WASKIN DO” Practice Location

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