Organization
GLASS DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDRIA B GLASS DO (PHYSICIAN/OWNER)
(910) 990-7722
Entity
Organization
Contact information
Practice address
412 E JOHNSON ST, CLINTON, NC 28328-2806
(910) 490-1240
(910) 490-1260
Mailing address
412 E JOHNSON ST, CLINTON, NC 28328-2806
(910) 490-1240
(910) 490-1260
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202101095
NC MEDICAL LICENSE
NC
Enumeration date
05/24/2021
Last updated
03/04/2022
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