Organization
INTERNAL MEDICINE OF GUILFORD LLC
Active
Organization
INTERNAL MEDICINE OF GUILFORD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES EVANS GLASS M.D. (SINGLE MEMBER OF LLC)
(203) 500-2080
Entity
Organization
Contact information
Practice address
96A BROAD ST, GUILFORD, CT 06437-2635
(203) 453-3621
Mailing address
96A BROAD ST, GUILFORD, CT 06437-2635
(203) 453-3621
(855) 736-5997
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
044810
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
044810
LICENSE NUMBER
CT
01
—
1184613705
NPI
CT
Enumeration date
11/03/2009
Last updated
09/19/2019
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