MEDICARE: EDWIN CHAPMAN GLASS 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	207U00000X	Nuclear Medicine Physician	C35240	CA
2	207UN0901X	Nuclear Cardiology Physician	C35240	CA
3	207UN0902X	Nuclear Imaging & Therapy Physician	C35240	CA
4	207UN0903X	In Vivo & In Vitro Nuclear Medicine Physician	C35240	CA

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	00C352400	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1629012612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN CHAPMAN GLASS M.D.

Provider Business Mailing Address
First Line	:	3271 ROSEWOOD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-1735
Country	:	US
Telephone Number	:	310-390-0761
Fax Number	:	310-268-4916

Provider Business Practice Location Address
First Line	:	2811 WILSHIRE BLVD
Second Line	:	SUITE 810
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4803
Country	:	US
Telephone Number	:	310-829-9788
Fax Number	:	310-268-4916

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/13/2007

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Directions to “ EDWIN CHAPMAN GLASS M.D.” Practice Location

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