MEDICARE: DR. BARRY M. GLASSMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0012283	FL

General Provider Information

NPI Number	:	1003110669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY M. GLASSMAN MD

Provider Business Mailing Address
First Line	:	2451 NE 199TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33180-1829
Country	:	US
Telephone Number	:	305-932-7403
Fax Number	:	305-935-3725

Provider Business Practice Location Address
First Line	:	2451 NE 199TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33180-1829
Country	:	US
Telephone Number	:	305-932-7403
Fax Number	:	305-935-3725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2010
Last Update Date	:	12/22/2010

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