MEDICARE: THOMAS A GLASS PH.D.

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	103T00000X	Psychologist	PSY037	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	56960	OTHER		NMSA

General Provider Information

NPI Number	:	1154310530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS A GLASS PH.D.

Provider Business Mailing Address
First Line	:	615 PIIKOI ST
Second Line	:	STE 1603
City	:	HONOLULU
State	:	HI
Zip	:	96814
Country	:	US
Telephone Number	:	808-596-8778
Fax Number	:	808-596-8558

Provider Business Practice Location Address
First Line	:	1833 KALAKAUA AVE
Second Line	:	SUITE 800
City	:	HONOLULU
State	:	HI
Zip	:	96815-1528
Country	:	US
Telephone Number	:	808-955-7372
Fax Number	:	808-951-9282

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	08/05/2011

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