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General NPI Number Information
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NPI Number | 1629012612
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Entity Type | Individual
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Provider Name | EDWIN CHAPMAN GLASS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 2811 WILSHIRE BLVD SUITE 810
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City | SANTA MONICA
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State | CA
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Zip | 90403-4803
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Country | US
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Telephone | 310-829-9788
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Fax | 310-268-4916
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Provider Business Mailing Address
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Address Line | 3271 ROSEWOOD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90066-1735
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Country | US
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Telephone | 310-390-0761
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Fax | 310-268-4916
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | C35240
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | C35240
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207UN0902X
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Taxonomy Name | Nuclear Imaging & Therapy Physician
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License Number | C35240
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207UN0903X
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Taxonomy Name | In Vivo & In Vitro Nuclear Medicine Physician
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License Number | C35240
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License Number State | CA
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