Individual
CHARLES J GRODZIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 N L ROGERS WELLS BLVD, GLASGOW, KY 42141-1300
(270) 659-5835
(270) 659-5856
Mailing address
310 N L ROGERS WELLS BLVD, GLASGOW, KY 42141-1300
(270) 659-5835
(270) 659-5856
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
34832
WV
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
C4709
KY
207RP1001X
Pulmonary Disease Physician
34832
WV
207RP1001X
Pulmonary Disease Physician
Primary
C4709
KY
207RP1001X
Pulmonary Disease Physician
L0226
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142057201
—
TX
05
—
142057203
—
TX
05
—
142057204
—
TX
05
—
142058002
—
TX
01
—
290013827
RR MEDICARE DENTO CO
TX
01
—
290013828
RR MEDICARE DALLAS CO
TX
01
—
8A2490
BCBS
TX
Enumeration date
03/02/2006
Last updated
01/19/2026
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