Healthcare Provider Details

I. General information

NPI: 1033388673
Provider Name (Legal Business Name): DONALD J GLAZER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 E PARHAM RD SUITE 318
HENRICO VA
23294-4371
US

IV. Provider business mailing address

7702 E PARHAM RD SUITE 318
HENRICO VA
23294-4371
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-2889
  • Fax: 804-750-1546
Mailing address:
  • Phone: 804-741-2889
  • Fax: 804-750-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103000433
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0103000433
License Number StateVA

VIII. Authorized Official

Name: DONALD JAY GLAZER
Title or Position: PODIATRIST/OWNER
Credential: DPM
Phone: 804-741-2889