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General NPI Number Information
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NPI Number | 1477552057
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Entity Type | Individual
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Provider Name | TIMOTHY ALLEN GLASS MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 8240 NAAB RD SUITE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46260
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Country | US
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Telephone | 317-872-9580
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Fax | 317-872-6043
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Provider Business Mailing Address
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Address Line | 11541 E WINCHESTER LN
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2040
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Country | US
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Telephone | 833-220-2685
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Fax | 317-947-0839
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01044838A
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License Number State | IN
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