Healthcare Provider Details

I. General information

NPI: 1891058111
Provider Name (Legal Business Name): PHILIP T.GLYNN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 CAREW ST
SPRINGFIELD MA
01104-2377
US

IV. Provider business mailing address

95 POST OFFICE PARK
WILBRAHAM MA
01095-1248
US

V. Phone/Fax

Practice location:
  • Phone: 413-748-7370
  • Fax: 413-748-7376
Mailing address:
  • Phone: 413-509-1000
  • Fax: 413-509-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number57384
License Number StateMA

VIII. Authorized Official

Name: DR. PHILIP T. GLYNN
Title or Position: OWNER
Credential: MD
Phone: 413-748-7370