Healthcare Provider Details

I. General information

NPI: 1063079309
Provider Name (Legal Business Name): VASSILI GLAZYRINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RIVERSIDE ST
NASHUA NH
03062-1304
US

IV. Provider business mailing address

4 ELLIOT WAY STE 200
MANCHESTER NH
03103-3553
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-3190
  • Fax: 603-577-3191
Mailing address:
  • Phone: 603-836-1590
  • Fax: 603-836-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number32139
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: