Provider Demographics
NPI:1629003744
Name:GLASER, MARK STUART (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STUART
Last Name:GLASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:524 BEAUMONT RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4443
Mailing Address - Country:US
Mailing Address - Phone:910-615-4372
Mailing Address - Fax:910-321-6232
Practice Address - Street 1:1638 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3424
Practice Address - Country:US
Practice Address - Phone:910-615-4372
Practice Address - Fax:910-321-6232
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22727207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC35746OtherBCBS OF NC
NCP00389963OtherRAILROAD MEDICARE
NC8935746Medicaid
NC194636OtherMEDCOST, DOCTORS DIRECT
NC35746OtherBCBS OF NC
NCP00389963OtherRAILROAD MEDICARE
NC212214BMedicare PIN