Healthcare Provider Details

I. General information

NPI: 1699731786
Provider Name (Legal Business Name): SCOTT ANDREW GLASSBURN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 PROFESSIONAL DR
WILLIAMSBURG VA
23185-3329
US

IV. Provider business mailing address

1155 PROFESSIONAL DR
WILLIAMSBURG VA
23185-3329
US

V. Phone/Fax

Practice location:
  • Phone: 757-220-3311
  • Fax: 757-220-9070
Mailing address:
  • Phone: 757-220-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103301268
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberWV 00257
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: