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General NPI Number Information
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NPI Number | 1306147798
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Entity Type | Organization
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Legal Business Name | GLI LLC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 1021 EDEN WAY N 124
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2776
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Country | US
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Telephone | 757-842-6757
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Fax | 757-842-6786
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Provider Business Mailing Address
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Address Line | 1021 EDEN WAY N 124
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2776
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Country | US
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Telephone | 757-842-6757
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Fax | 757-842-6786
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GARY LEE INSLEY
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Credential | N.D.
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Telephone | 757-842-6757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 101016018
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 101239530
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License Number State | VA
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