Healthcare Provider Details

I. General information

NPI: 1992742688
Provider Name (Legal Business Name): VLADIMIR M GLEYZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN STREET NORTH READING PEDIATRICS
NORTH READING MA
01864
US

IV. Provider business mailing address

7 HERITAGE LN
SAUGUS MA
01906-3188
US

V. Phone/Fax

Practice location:
  • Phone: 978-664-4698
  • Fax:
Mailing address:
  • Phone: 978-664-4698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number159410
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: