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NPI Code Detail

MEDICARE: DR. KENNETH DAVID GLASS MD

MEDICARE: DR. KENNETH DAVID 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
12084P0800XPsychiatry Physician35043556OH

Other Identifiers

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

General Provider Information

NPI Number : 1417934340
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH DAVID GLASS MD
Provider Business Mailing Address
First Line : 1101 SUMMIT RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45237-2621
Country : US
Telephone Number : 513-948-3600
Fax Number : 513-948-8631
Provider Business Practice Location Address
First Line : 1101 SUMMIT RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45237-2621
Country : US
Telephone Number : 513-948-3600
Fax Number : 513-948-8631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 08/05/2009

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Directions to “ DR. KENNETH DAVID GLASS MD” Practice Location

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