1356540942 NPI number — GLASGOW FAMILY PRACTICE

Table of content: (NPI 1356540942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356540942 NPI number — GLASGOW FAMILY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLASGOW FAMILY PRACTICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356540942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 GLASGOW AVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-4773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-836-8200
Provider Business Mailing Address Fax Number:
302-836-4302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4633 OGLETOWN STANTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-737-1085
Provider Business Practice Location Address Fax Number:
302-737-4745
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
302-737-1085

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2646541000 . This is a "KEYSTONE AND AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com