Provider Demographics
NPI:1982881389
Name:GLUCK, GINA E (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:E
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-200-5590
Mailing Address - Fax:
Practice Address - Street 1:20 YORK STREET
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8042
Practice Address - Country:US
Practice Address - Phone:203-200-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02085R0202X
CT0493492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology