1134786171 NPI number — DR. BRYAN ADAM GLEZERSON MD , FRCPC

Table of content: DR. BRYAN ADAM GLEZERSON MD , FRCPC (NPI 1134786171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134786171 NPI number — DR. BRYAN ADAM GLEZERSON MD , FRCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLEZERSON
Provider First Name:
BRYAN
Provider Middle Name:
ADAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD , FRCPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134786171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/13/2020
NPI Reactivation Date:
01/27/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104-939 NORTH RIVER RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTTAWA
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
K1K3V2
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPARTMENT OF ANESTHESIOLOGY - BWH
Provider Second Line Business Practice Location Address:
75 FRANCIS STREET
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-732-8210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)