Provider Demographics
NPI:1437307659
Name:SERAFIMA M. GLOUZGAL
Entity Type:Organization
Organization Name:SERAFIMA M. GLOUZGAL
Other - Org Name:SERAFIMA M. GLOUZGAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SERAFIMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLOUZGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-431-1942
Mailing Address - Street 1:38B GROVE ST
Mailing Address - Street 2:UNIT L-B
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4665
Mailing Address - Country:US
Mailing Address - Phone:203-431-1942
Mailing Address - Fax:
Practice Address - Street 1:38B GROVE ST
Practice Address - Street 2:UNIT L-B
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4665
Practice Address - Country:US
Practice Address - Phone:203-431-1942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT036381OtherCONNECTICUT STATE LICENSE