1447499819 NPI number — BROOKE REITER GLESSING M.D.

Table of content: BROOKE REITER GLESSING M.D. (NPI 1447499819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447499819 NPI number — BROOKE REITER GLESSING M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLESSING
Provider First Name:
BROOKE
Provider Middle Name:
REITER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAGGENSTOS
Provider Other First Name:
BROOKE
Provider Other Middle Name:
REITER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447499819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20800 HARVARD RD
Provider Second Line Business Mailing Address:
2ND FLR
Provider Business Mailing Address City Name:
HIGHLAND HILLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-7251
Provider Business Mailing Address Country Code:
US
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:
11100 EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44106-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-844-8500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2009

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: 207RG0100X , with the licence number:  56555 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 35-124313 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0108238 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".