Provider Demographics
NPI:1356668388
Name:GLEW, TIMOTHY JAMES (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAMES
Last Name:GLEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 WOODLAND ST
Mailing Address - Street 2:SUITE 35
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2372
Mailing Address - Country:US
Mailing Address - Phone:860-525-1234
Mailing Address - Fax:860-278-8782
Practice Address - Street 1:19 WOODLAND ST
Practice Address - Street 2:SUITE 35
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2372
Practice Address - Country:US
Practice Address - Phone:860-525-1234
Practice Address - Fax:860-278-8782
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT055034207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease