Provider Demographics
NPI:1538191911
Name:GUGLIN, CHARLES (MD FACS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:GUGLIN
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 BOSTON POST RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3536
Mailing Address - Country:US
Mailing Address - Phone:203-878-6377
Mailing Address - Fax:203-876-0652
Practice Address - Street 1:831 BOSTON POST RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3536
Practice Address - Country:US
Practice Address - Phone:203-878-6377
Practice Address - Fax:203-876-0652
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25313208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001263755Medicaid
D98355Medicare UPIN
CT020001624Medicare ID - Type Unspecified