Individual
LAWRENCE GLUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 DIVISION ST, DERBY, CT 06418-1326
(203) 735-8769
Mailing address
PO BOX 8416, NEW HAVEN, CT 06530-0416
(203) 777-6209
(203) 787-2431
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
017422
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174226
—
CT
Enumeration date
09/20/2005
Last updated
07/30/2007
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