Provider Demographics
NPI:1669404984
Name:GLASSBURN, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:GLASSBURN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2358
Mailing Address - Country:US
Mailing Address - Phone:856-582-3008
Mailing Address - Fax:856-582-3009
Practice Address - Street 1:900 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2358
Practice Address - Country:US
Practice Address - Phone:856-582-3008
Practice Address - Fax:856-582-3009
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD009725E2085R0203X
NJ25MA03345200207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007534600002Medicaid
PA0007534600002Medicaid
PA119608Medicare ID - Type Unspecified