Healthcare Provider Details

I. General information

NPI: 1669835583
Provider Name (Legal Business Name): MADELINE GLASSER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12428 W THUNDERBIRD RD
EL MIRAGE AZ
85335-3113
US

IV. Provider business mailing address

2929 E THOMAS RD
PHOENIX AZ
85016-8034
US

V. Phone/Fax

Practice location:
  • Phone: 623-344-6500
  • Fax: 623-344-6501
Mailing address:
  • Phone: 602-470-5000
  • Fax: 602-470-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6779
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: