Individual
CHARLES T MCGLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 GATEWAY LOOP, SPRINGFIELD, OR 97477-1176
(036) 837-7305
(541) 204-1997
Mailing address
1200 GATEWAY LOOP, SPRINGFIELD, OR 97477-1176
(036) 837-7305
(541) 204-1997
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD15480
OR
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD15480
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210260
—
OR
05
—
8296675
—
WA
05
—
MD8960R
—
AK
05
—
MD8961R
—
AK
Enumeration date
07/12/2006
Last updated
12/22/2021
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