1881657112 NPI number — LAWRENCE MARK GLANZ PH D

Table of content: LAWRENCE MARK GLANZ PH D (NPI 1881657112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881657112 NPI number — LAWRENCE MARK GLANZ PH D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLANZ
Provider First Name:
LAWRENCE
Provider Middle Name:
MARK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH D
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:
1881657112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 NORTH CRAIG STREET
Provider Second Line Business Mailing Address:
SUITE 170
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-687-8700
Provider Business Mailing Address Fax Number:
412-687-6808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 NORTH CRAIG STREET
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-687-8700
Provider Business Practice Location Address Fax Number:
412-687-6808
Provider Enumeration Date:
04/08/2006

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: 103T00000X , with the licence number:  PS003286L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0014932200002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 279970 . This is a "VALUE OPTIONS NON PAR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 045720 . This is a "GALAXY HEALTH NETWORK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 170328 . This is a "ACS MHN CLAIMS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 162753 . This is a "HIGHMARK INC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4563150 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1933612 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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