Healthcare Provider Details

I. General information

NPI: 1013077940
Provider Name (Legal Business Name): JENNIFER SARAH HAHN GLAZER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HOSPITAL DR
CHEVERLY MD
20785-1189
US

IV. Provider business mailing address

5429 TILDEN RD
BLADENSBURG MD
20710-1562
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-3550
  • Fax:
Mailing address:
  • Phone: 301-802-2593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003375
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: