Provider Demographics
NPI:1336456821
Name:LAWRENCE GLAUBIGER M D LLC
Entity Type:Organization
Organization Name:LAWRENCE GLAUBIGER M D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MANN
Authorized Official - Last Name:GLAUBIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-749-6762
Mailing Address - Street 1:146 HAZARD AVE
Mailing Address - Street 2:#203
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4571
Mailing Address - Country:US
Mailing Address - Phone:860-749-6762
Mailing Address - Fax:860-749-6781
Practice Address - Street 1:146 HAZARD AVE
Practice Address - Street 2:#203
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4571
Practice Address - Country:US
Practice Address - Phone:860-749-6762
Practice Address - Fax:860-749-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040213207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001402130Medicaid
CT001402130Medicaid