Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 58196 | MA |
Y | 111NI0900X | Internist | 58196 | MA |
N | 207RA0401X | Internist - Addiction Medicine | 58196 | MA |
NPI | 1477504637 |
---|---|
Provider Name | Oscar Glieberman |
First Address | Providence, RI 02906-4834 |
Second Address | Providence, RI 02906-4834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 04/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3071383 | (05) | MA |
C90409 | (02) |