| Internal Medicine Of Guilford Llc | |
|
96a Broad St Guilford CT 06437-2635 | |
| (203) 453-3621 | |
| Not Available |
| Full Name | Internal Medicine Of Guilford Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 96a Broad St, Guilford, Connecticut |
| Authorized Official Name and Position | Charles Evans Glass (SINGLE MEMBER OF LLC) |
| Authorized Official Contact | 2035002080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Of Guilford Llc 96a Broad St Guilford CT 06437-2635 Ph: (203) 453-3621 | Internal Medicine Of Guilford Llc 96a Broad St Guilford CT 06437-2635 Ph: (203) 453-3621 |
| NPI Number | 1457688020 |
|---|---|
| Provider Enumeration Date | 11/03/2009 |
| Last Update Date | 09/19/2019 |
| Medicare PECOS PAC ID | 0749324739 |
|---|---|
| Medicare Enrollment ID | O20100215000065 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457688020 | NPI | - | NPPES |
| 1184613705 | Other | CT | NPI |
| 044810 | Other | CT | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 044810 (Connecticut) | Primary |
| Provider Name | Charles Glass |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184613705 PECOS PAC ID: 8921087362 Enrollment ID: I20061216000002 |
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