Healthcare Provider Details

I. General information

NPI: 1538194287
Provider Name (Legal Business Name): GLENN SAXE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE DOWLING 1
BOSTON MA
02118
US

IV. Provider business mailing address

850 HARRISON AVE DOWLING 1
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-7504
  • Fax: 617-414-7534
Mailing address:
  • Phone: 617-414-7504
  • Fax: 617-414-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMA73413
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: