Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 35054 | MA |
NPI | 1699830075 |
---|---|
Provider Name | Hyman Glick |
First Address | Boston, MA 02215-3904 |
Second Address | Boston, MA 02215-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 04/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014435 | NHP (01) | MA |
2002078 | (05) | MA |
4414144-001 | CIGNA (01) | MA |
705098 | TUFTS (01) | MA |
B206 | HPHC (01) | MA |
B75801 | (02) | MA |
M08320 | BCBS (01) | MA |