Provider Demographics
NPI:1730179359
Name:LAMURAGLIA, GLENN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:MICHAEL
Last Name:LAMURAGLIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-6997
Mailing Address - Fax:617-724-1921
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 464
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-6997
Practice Address - Fax:617-724-1921
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA491452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3012255Medicaid
MA049145OtherTUFTS HEALTH PLAN
MAB39202OtherBCBS MA
MAB39202Medicare ID - Type Unspecified
A36272Medicare UPIN