Healthcare Provider Details

I. General information

NPI: 1669404984
Provider Name (Legal Business Name): JOHN R GLASSBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MEDICAL CENTER DR SUITE 100
SEWELL NJ
08080-2358
US

IV. Provider business mailing address

900 MEDICAL CENTER DR SUITE 100
SEWELL NJ
08080-2358
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-3008
  • Fax: 856-582-3009
Mailing address:
  • Phone: 856-582-3008
  • Fax: 856-582-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberMD009725E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25MA03345200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: