Doctor Name: | MR. RAIMUND R GLOSSON |
NPI Number: | 1477543379 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHYSICIAN ASSISTANT |
License Number: | 0110001204 |
Business Practice Address: | 576 Jefferson Ave Fort Eustis, VA - 236041602 |
Business Phone Number: | 7573147595 |
Business Fax Number: | 7573147601 |
Mailing Address: | 104 York Ln, YORKTOWN |
State: | VA |
Postal Code: | 236924029 |
Phone Number: | 7578902710 |
Fax Number: | |
NPI Enumeration Date: | 10/24/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 0110001204 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |