Organization
MASS BAY UROLOGIC ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLIFFORD D GLUCK M.D. (OWNER)
(617) 296-2222
Entity
Organization
Contact information
Practice address
2100 DORCHESTER AVE, SUITE 2206, DORCHESTER CENTER, MA 02124-5615
(617) 296-2222
(617) 296-3834
Mailing address
72 SHARP ST, HINGHAM, MA 02043-4351
(781) 337-0201
(781) 335-3674
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
57617
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9774106
—
MA
01
—
M16068
BC/BS MA
MA
Enumeration date
07/26/2005
Last updated
09/24/2010
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