Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1249 | ME |
Y | 213ES0000X | Sports Medicine | 1249 | ME |
NPI | 1235349879 |
---|---|
Provider Name | Dr. Jane Glass |
First Address | Cape Elizabeth, ME 04107-1341 |
Second Address | Portland, ME 04102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |