Provider Demographics
NPI:1851393342
Name:GLUCK, CLIFFORD D (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:D
Last Name:GLUCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:72 SHARP ST
Mailing Address - Street 2:A-10
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4351
Mailing Address - Country:US
Mailing Address - Phone:781-337-0201
Mailing Address - Fax:781-335-3674
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:SUITE 2206
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5615
Practice Address - Country:US
Practice Address - Phone:617-296-2222
Practice Address - Fax:617-296-3834
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2012-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA57617208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3061523Medicaid
MA3061523Medicaid
MAJ09623Medicare ID - Type Unspecified