Provider Demographics
NPI:1184913675
Name:GLASS, ELEANOR L (MD)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:L
Last Name:GLASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 VICTORY PKWY STE 603
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2837
Mailing Address - Country:US
Mailing Address - Phone:513-457-4073
Mailing Address - Fax:513-429-4778
Practice Address - Street 1:2200 VICTORY PKWY STE 603
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2837
Practice Address - Country:US
Practice Address - Phone:513-457-4073
Practice Address - Fax:513-429-4778
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine