MEDICARE: DR. PETER LOUIS GLICKMAN 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	2085R0202X	Diagnostic Radiology Physician	MD426075	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	P00229796	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	231955165	OTHER	PA	INTERGROUP SERVICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MD426075	OTHER	PA	HEALTH PARTNERS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	231955165	OTHER	PA	AETNA
9	2393615000	OTHER	PA	KHPE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	1725277	OTHER	PA	HIGHMARK BLUE SHIELD
14	2393615000	OTHER	PA	IBC
15	30020753	OTHER	PA	KEYSTONE MERCY
16	9336768	OTHER	PA	PHCS
17	PA7584	OTHER	PA	HEALTHNET
18	101234464	OTHER	PA	AMERICHOICE OF PA
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659350734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER LOUIS GLICKMAN M.D.

Provider Business Mailing Address
First Line	:	450 E 20TH ST
Second Line	:	APT 8H
City	:	NEW YORK
State	:	NY
Zip	:	10009-8238
Country	:	US
Telephone Number	:	646-244-7856
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 E 77TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10075-1817
Country	:	US
Telephone Number	:	212-772-3111
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	08/05/2015

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