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General NPI Number Information
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NPI Number | 1659350734
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Entity Type | Individual
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Provider Name | PETER LOUIS GLICKMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 61 E 77TH ST
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City | NEW YORK
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State | NY
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Zip | 10075-1817
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Country | US
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Telephone | 212-772-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 450 E 20TH ST APT 8H
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City | NEW YORK
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State | NY
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Zip | 10009-8238
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Country | US
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Telephone | 646-244-7856
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD426075
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License Number State | PA
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