Individual
TIMOTHY ALLEN GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8240 NAAB RD, SUITE 100, INDIANAPOLIS, IN 46260
(317) 872-9580
(317) 872-6043
Mailing address
11541 E WINCHESTER LN, ELLICOTT CITY, MD 21042-2040
(833) 220-2685
(317) 947-0839
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01044838A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1009224
TRICARE
IN
05
—
200073640
—
IN
Enumeration date
07/18/2005
Last updated
08/03/2018
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