Healthcare Provider Details

I. General information

NPI: 1851470595
Provider Name (Legal Business Name): DOUGLAS J GLOD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WAMPANOG TRAIL SUITE 205
EAST PROVIDENCE RI
02915
US

IV. Provider business mailing address

250 WAMPANOG TRAIL SUITE 205
EAST PROVIDENCE RI
02915
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-0283
  • Fax: 401-438-5956
Mailing address:
  • Phone: 401-431-0283
  • Fax: 401-438-5956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM00234
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: