MEDICARE: DR. LAWRENCE RICHARD GLASSMAN 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	162023	NY

General Provider Information

NPI Number	:	1831269281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE RICHARD GLASSMAN MD

Provider Business Mailing Address
First Line	:	225 COMMUNITY DR
Second Line	:	DIVISION OF THORACIC SURGERY - SUITE 110
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5503
Country	:	US
Telephone Number	:	516-918-4388
Fax Number	:	516-918-4387

Provider Business Practice Location Address
First Line	:	225 COMMUNITY DR
Second Line	:	DIVISION OF THORACIC SURGERY - SUITE 110
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5503
Country	:	US
Telephone Number	:	516-918-4388
Fax Number	:	516-918-4387

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/13/2012

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