Internal Medicine Of Guilford Llc | |
96a Broad St Guilford CT 06437-2635 | |
(203) 453-3621 | |
Not Available |
Full Name | Internal Medicine Of Guilford Llc |
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Speciality | Internal Medicine |
Location | 96a Broad St, Guilford, Connecticut |
Authorized Official Name and Position | Charles Evans Glass (SINGLE MEMBER OF LLC) |
Authorized Official Contact | 2035002080 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Internal Medicine Of Guilford Llc 96a Broad St Guilford CT 06437-2635 Ph: (203) 453-3621 | Internal Medicine Of Guilford Llc 96a Broad St Guilford CT 06437-2635 Ph: (203) 453-3621 |
NPI Number | 1457688020 |
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Provider Enumeration Date | 11/03/2009 |
Last Update Date | 09/19/2019 |
Medicare PECOS PAC ID | 0749324739 |
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Medicare Enrollment ID | O20100215000065 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457688020 | NPI | - | NPPES |
1184613705 | Other | CT | NPI |
044810 | Other | CT | LICENSE NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 044810 (Connecticut) | Primary |
Provider Name | Charles Glass |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1184613705 PECOS PAC ID: 8921087362 Enrollment ID: I20061216000002 |
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