Provider Demographics
NPI:1053417451
Name:GLICKMAN, HAROLD BRUCE (DPM)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:BRUCE
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5513 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2647
Mailing Address - Country:US
Mailing Address - Phone:202-833-9797
Mailing Address - Fax:202-833-9799
Practice Address - Street 1:5513 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 210
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2647
Practice Address - Country:US
Practice Address - Phone:202-833-9797
Practice Address - Fax:202-833-9799
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCP0265213E00000X
MD00324213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC406480171OtherRR MEDICARE #
DC407130Medicare PIN
T31109Medicare UPIN