MEDICARE: KATHRYN B 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
1	208000000X	Pediatrics Physician	0101225444	VA
2	208000000X	Pediatrics Physician	P1458	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	432058755	OTHER	VA	PHCS
2	4768718/9149430	OTHER	VA	CIGNA
3	3649627	OTHER	VA	AETNA HMO
4	41232	OTHER	VA	OPTIMA HEALTH
5	7358237	OTHER	VA	AETNA PPO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	294140	OTHER	VA	ANTHEM BC
8	633510	OTHER	VA	SOUTHERN HEALTH
9	432058755	OTHER	VA	GREAT WEST
10	432058755	OTHER	VA	TRICARE
11	8165265	OTHER	VA	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1508831876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN B GLASS MD

Provider Business Mailing Address
First Line	:	909 FROSTWOOD DR
Second Line	:	SUITE 1.100
City	:	HOUSTON
State	:	TX
Zip	:	77024-2301
Country	:	US
Telephone Number	:	713-338-4523
Fax Number	:	713-338-5500

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST STE 2015
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1521
Country	:	US
Telephone Number	:	713-704-0669
Fax Number	:	713-704-0670

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	01/19/2012

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Directions to “ KATHRYN B GLASS MD” Practice Location

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