MEDICARE: MR. EDWARD GLASSBERG M.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	174400000X	Specialist	G61252	CA
2	207NS0135X	Procedural Dermatology Physician	G61252	CA
3	207ND0101X	MOHS-Micrographic Surgery Physician	G61252	CA

General Provider Information

NPI Number	:	1154387413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD GLASSBERG M.D.

Provider Business Mailing Address
First Line	:	3828 SCHAUFELE AVE STE 300
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1793
Country	:	US
Telephone Number	:	562-997-1144
Fax Number	:	562-989-3612

Provider Business Practice Location Address
First Line	:	3828 SCHAUFELE AVE STE 300
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1793
Country	:	US
Telephone Number	:	562-997-1144
Fax Number	:	562-989-3612

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	11/02/2020

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Directions to “ MR. EDWARD GLASSBERG M.D.” Practice Location

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