Healthcare Provider Details

I. General information

NPI: 1487032488
Provider Name (Legal Business Name): DANIEL GLASER M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST YNHH - DEPARTMENT OF PEDIATRICS
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

PO BOX 208064
NEW HAVEN CT
06520-8064
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-1947
  • Fax:
Mailing address:
  • Phone: 203-246-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD465877
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number68777
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: