Provider Demographics
NPI:1144323957
Name:GLASS, BILLY L (MD)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:L
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1001 NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5253
Mailing Address - Country:US
Mailing Address - Phone:252-635-6777
Mailing Address - Fax:252-635-9641
Practice Address - Street 1:1001 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5253
Practice Address - Country:US
Practice Address - Phone:252-672-7738
Practice Address - Fax:252-635-6951
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601617207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902429Medicaid
NC4993975OtherCIGNA HEALTHCARE
NCP00277932OtherRAILROAD MEDICARE
NC141ATOtherBCBSNC
NC184407OtherMEDCOST
NC2048604Medicare PIN
NCP00277932OtherRAILROAD MEDICARE