Provider Demographics
NPI:1053370742
Name:MARESCA, GLAUCO MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:GLAUCO
Middle Name:MICHAEL
Last Name:MARESCA
Suffix:
Gender:
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:PO BOX 41643
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21203-6643
Mailing Address - Country:US
Mailing Address - Phone:315-265-4924
Mailing Address - Fax:315-268-1723
Practice Address - Street 1:50 LEROY ST
Practice Address - Street 2:CANTON-POTSDAM HOSPITAL
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1786
Practice Address - Country:US
Practice Address - Phone:315-265-4924
Practice Address - Fax:315-268-1723
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177246-12085R0203X
NY1772462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE89822Medicare UPIN