Provider Demographics
NPI:1063692648
Name:GLASGOW INTERNAL MEDICINE ASSOCIATES PA
Entity type:Organization
Organization Name:GLASGOW INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CURT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BLACKLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-836-0100
Mailing Address - Street 1:2600 GLASGOW AVE
Mailing Address - Street 2:SUITE 126
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4773
Mailing Address - Country:US
Mailing Address - Phone:302-836-0100
Mailing Address - Fax:302-836-5244
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 126
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-836-0100
Practice Address - Fax:302-836-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20003134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DED00167OtherDCS
DE239903Medicaid
DE239903Medicaid
DEE36826Medicare UPIN
DEBB1598436OtherDEA