Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 3159 | OH |
Y | 213ER0200X | Radiology | 3159 | OH |
NPI | 1467489922 |
---|---|
Provider Name | Dr. Benjamin L Glass |
First Address | North Royalton, OH 44133-9828 |
Second Address | North Royalton, OH 44133-1069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |