Healthcare Provider Details

I. General information

NPI: 1245228139
Provider Name (Legal Business Name): HELENE L GLASSBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BOULEVARD EAST PAVILION, 2ND FLOOR
PHILADELPHIA PA
19104-4306
US

IV. Provider business mailing address

3400 CIVIC CENTER BOULEVARD EAST PAVILION, 2ND FLOOR
PHILADELPHIA PA
19104-4306
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-4949
  • Fax: 215-615-0829
Mailing address:
  • Phone: 215-615-4949
  • Fax: 215-615-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD071616L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD071616L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: