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NPI Code Detail

MEDICARE: ROGER IVAN GLASS MD

MEDICARE:   ROGER IVAN GLASS  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
1207R00000XInternal Medicine Physician18654GA

General Provider Information

NPI Number : 1255294369
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER IVAN GLASS MD
Provider Business Mailing Address
First Line : 918 OAKDALE RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30307-1212
Country : US
Telephone Number : 470-433-6266
Fax Number :
Provider Business Practice Location Address
First Line : 918 OAKDALE RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30307-1212
Country : US
Telephone Number : 470-433-6266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2025
Last Update Date : 12/05/2025

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Directions to “ ROGER IVAN GLASS MD” Practice Location

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