Individual
DR. MARY GLASS
Active
Individual
DR. MARY GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01041573
IN
208M00000X
Hospitalist Physician
01041573A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200088280
—
IN
01
—
471400001
MEDICARE PROVIDER PTAN
IN
Enumeration date
04/14/2006
Last updated
03/02/2023
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