Basic Information
| Provider Information | |||||||||
| NPI: | 1194752089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLASER | ||||||||
| FirstName: | LEONARD | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11390 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393484221 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8340 COLLIER BLVD STE 405 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393484221 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 022003 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME139291 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103666800 | 05 | FL | MEDICAID | 1220037 | 05 | CT | MEDICAID | 2V0711 | 01 | CT | HEALTH NET | OTHER | 4002857 | 01 | CT | AETNA | OTHER | 050632 | 01 | CT | CONNCARE | OTHER | 110217801 | 01 | CT | RR MEDICARE | OTHER | HAP004 | 01 | CT | OXFORD | OTHER |