Provider Demographics
NPI:1225066335
Name:GLASS, TODD F (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:F
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-298-7371
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1717 S. ORANGE AVE., SUITE 100
Practice Address - Street 2:NEMOURS CHILDREN'S CLINIC, ORLANDO
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:407-650-7715
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-07-48502080P0204X
FLME111854207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine