MEDICARE: JOHN E. GLASSCO, MD, INC.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1023002672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN E. GLASSCO, MD, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2311
Second Line	:
City	:	CHATSWORTH
State	:	CA
Zip	:	91313-2311
Country	:	US
Telephone Number	:	818-718-9500
Fax Number	:	818-718-9507

Provider Business Practice Location Address
First Line	:	4929 VAN NUYS BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1702
Country	:	US
Telephone Number	:	818-907-4561
Fax Number	:	818-907-2810

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN E GLASSCO
Credential	:	M.D.
Telephone Number	:	818-907-4561

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	06/17/2009

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