Provider Demographics
NPI:1184613705
Name:GLASS, CHARLES E (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:96A BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2635
Mailing Address - Country:US
Mailing Address - Phone:203-453-3621
Mailing Address - Fax:203-453-4501
Practice Address - Street 1:96A BROAD ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2635
Practice Address - Country:US
Practice Address - Phone:203-453-3621
Practice Address - Fax:203-453-4501
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT044810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1457688020OtherNPI FOR PRIVATE SOLO PRACTICE: INTERNAL MEDICINE OF GUILFORD LLC NPI
CT110010081Medicare PIN
CT1457688020OtherNPI FOR PRIVATE SOLO PRACTICE: INTERNAL MEDICINE OF GUILFORD LLC NPI