Provider Demographics
NPI:1548255078
Name:GLASSMAN, KENNETH P (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:P
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SPRUCE ST
Mailing Address - Street 2:100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7126
Mailing Address - Country:US
Mailing Address - Phone:303-394-2828
Mailing Address - Fax:303-320-0242
Practice Address - Street 1:200 SPRUCE ST
Practice Address - Street 2:100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7126
Practice Address - Country:US
Practice Address - Phone:303-394-2828
Practice Address - Fax:303-320-0242
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-01-13
Deactivation Date:2022-08-23
Deactivation Code:
Reactivation Date:2023-01-13
Provider Licenses
StateLicense IDTaxonomies
CO25891174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COGL73764OtherBLUE CROSS BLUE SHIELD
CO01258912Medicaid
CO01258912Medicaid
COE60786Medicare UPIN