Healthcare Provider Details

I. General information

NPI: 1750352829
Provider Name (Legal Business Name): THOMAS A GLASSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 FULTON AVE
SHERMAN OAKS CA
91423-3907
US

IV. Provider business mailing address

4330 FULTON AVE
SHERMAN OAKS CA
91423-3907
US

V. Phone/Fax

Practice location:
  • Phone: 818-784-1102
  • Fax: 818-784-1653
Mailing address:
  • Phone: 818-784-1102
  • Fax: 818-784-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG28902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: