MEDICARE: SERAFIMA M. GLOUZGAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036381	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036381	OTHER	CT	CONNECTICUT STATE LICENSE

General Provider Information

NPI Number	:	1437307659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERAFIMA M. GLOUZGAL

Provider Business Mailing Address
First Line	:	38B GROVE ST
Second Line	:	UNIT L-B
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4665
Country	:	US
Telephone Number	:	203-431-1942
Fax Number	:

Provider Business Practice Location Address
First Line	:	38B GROVE ST
Second Line	:	UNIT L-B
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4665
Country	:	US
Telephone Number	:	203-431-1942
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. SERAFIMA M GLOUZGAL
Credential	:	M.D.
Telephone Number	:	203-431-1942

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	04/07/2010

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