Basic Information
| Provider Information | |||||||||
| NPI: | 1053300095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLAZER | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 ALICE PECK DAY DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037662901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034483122 | ||||||||
| FaxNumber: | 6034487491 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 ALICE PECK DAY DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037662900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034483122 | ||||||||
| FaxNumber: | 6034487491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 04/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7117 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30009660 | 05 | NH | MEDICAID | 0457500 | 01 | TRICARE | OTHER | 1161027 | 01 | CIGNA | OTHER | 1001474 | 05 | VT | MEDICAID | 0104575YPNH01 | 01 | ANTHEM BCBS | OTHER | 00001747 | 01 | VT | VT BCBS | OTHER |