Basic Information
Provider Information | |||||||||
NPI: | 1225129604 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GLASSTETTER | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: | S | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 200 HYGEIA DRIVE SUITE 2300 | ||||||||
Address2: | CCHS PHYSICIAN CONTRACTING | ||||||||
City: | NEWARK | ||||||||
State: | DE | ||||||||
PostalCode: | 197132049 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 501 W 14TH ST | ||||||||
Address2: | WILMINGTON HOSPITAL HEALTH CENTER | ||||||||
City: | WILMINGTON | ||||||||
State: | DE | ||||||||
PostalCode: | 198011013 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3023204410 | ||||||||
FaxNumber: | 3024284078 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/28/2006 | ||||||||
LastUpdateDate: | 11/09/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C10003927 | DE | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208D00000X | C10003927 | DE | N |   | Allopathic & Osteopathic Physicians | General Practice |   | 208D00000X | C1-0003927 | DE | N |   | Allopathic & Osteopathic Physicians | General Practice |   | 208000000X | C1-0003927 | DE | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 1426522 | 05 | PA |   | MEDICAID | 1989316 | 05 | MD |   | MEDICAID | 5479801 | 05 | NJ |   | MEDICAID | 1528312 | 05 | NY |   | MEDICAID |