Healthcare Provider Details

I. General information

NPI: 1134939580
Provider Name (Legal Business Name): ERIC DAVID GLASS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TUSKEGEE BLVD
DOVER AFB DE
19902-5003
US

IV. Provider business mailing address

300 TUSKEGEE BLVD
DOVER AFB DE
19902-5003
US

V. Phone/Fax

Practice location:
  • Phone: 302-241-5913
  • Fax:
Mailing address:
  • Phone: 302-241-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1249025
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: