Basic Information
| Provider Information | |||||||||
| NPI: | 1134786171 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLEZERSON | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | ADAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD , FRCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104-939 NORTH RIVER RD. | ||||||||
| Address2: | |||||||||
| City: | OTTAWA | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | K1K3V2 | ||||||||
| CountryCode: | CA | ||||||||
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| Practice Location | |||||||||
| Address1: | DEPARTMENT OF ANESTHESIOLOGY - BWH | ||||||||
| Address2: | 75 FRANCIS STREET | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177328210 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2019 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/13/2020 | ||||||||
| NPIReactivationDate: | 01/27/2020 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.