Healthcare Provider Details

I. General information

NPI: 1366371429
Provider Name (Legal Business Name): RACHEL GLOCK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HAWLEY LN STE 1120
STRATFORD CT
06614-1208
US

IV. Provider business mailing address

99 HAWLEY LN STE 1120
STRATFORD CT
06614-1208
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-5988
  • Fax: 203-380-0531
Mailing address:
  • Phone: 203-377-5988
  • Fax: 203-380-0531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7580
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: