Individual
JONATHAN NEIL GLICKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PHD
Contact information
Practice address
320 NEEDHAM STREET, SUITE 200, NEWTON, MA 02464
(617) 969-4100
(617) 969-3393
Mailing address
PO BOX 840294, DALLAS, TX 75284-0294
(888) 344-1160
(972) 331-3148
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
158613
MA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
158613
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3196046
—
MA
Enumeration date
06/26/2006
Last updated
11/21/2013
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