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Organization
SHORELINE PEDIATRICS & ADOLESCENT MEDICINE, P.C.
Active
Organization
SHORELINE PEDIATRICS & ADOLESCENT MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD H. GLEICH M.D. (PRESIDENT)
(203) 421-3600
Entity
Organization
Contact information
Practice address
1110 DURHAM RD, MADISON, CT 06443-1858
(203) 421-3600
(203) 421-3627
Mailing address
1110 DURHAM RD, MADISON, CT 06443-1858
(203) 421-3600
(203) 421-3627
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
04/28/2006
Last updated
08/22/2020
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