Provider Demographics
NPI:1902850126
Name:GLOSTER, HUGH M JR (M D)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:M
Last Name:GLOSTER
Suffix:JR
Gender:M
Credentials:M D
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 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5505
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:3130 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2399
Practice Address - Country:US
Practice Address - Phone:513-584-3686
Practice Address - Fax:513-475-7636
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.067219207N00000X, 207ND0101X
FLME133595207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH070007630OtherMEDICARE/RR/PIN
KY64955925Medicaid
OH0976663Medicaid
OH070007630OtherMEDICARE/RR/PIN
OHH044750Medicare PIN
KY00100002Medicare PIN
OHGLO764571Medicare PIN
OH070007630OtherMEDICARE/RR/PIN