Healthcare Provider Details

I. General information

NPI: 1881229672
Provider Name (Legal Business Name): MICHAEL SETH GLICKSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 REHABILITATION WAY
WOBURN MA
01801-6003
US

IV. Provider business mailing address

60 KILMARNOCK ST APT 401
BOSTON MA
02215-4870
US

V. Phone/Fax

Practice location:
  • Phone: 781-935-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1022369
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: