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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