Provider Demographics
NPI:1164622981
Name:GLASS, JONATHAN SAUL (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SAUL
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 BORTHWICK AVE STE 303
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7109
Practice Address - Country:US
Practice Address - Phone:603-431-5205
Practice Address - Fax:603-436-4257
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236793207N00000X
NH15186207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology