Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 00324 | MD |
N | 222Z00000X | Podiatrist | 00324 | MD |
Y | 213E00000X | Podiatrist | P0265 | DC |
Y | 222Z00000X | Podiatrist | P0265 | DC |
NPI | 1053417451 |
---|---|
Provider Name | Dr. Harold Bruce Glickman |
First Address | Washington, DC 20015-2647 |
Second Address | Washington, DC 20015-2647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 09/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
406480171 | RR MEDICARE # (01) | DC |
T31109 | (02) |