Basic Information
| Provider Information | |||||||||
| NPI: | 1700994563 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLASGOW | ||||||||
| FirstName: | CONSTANCE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 942A ROUTE 146 | ||||||||
| Address2: | |||||||||
| City: | CLIFTON PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120653614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183718000 | ||||||||
| FaxNumber: | 5183715338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 087161 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000401143002 | 01 | NY | BSNENY | OTHER | 00550734 | 05 | NY | MEDICAID | 47335 | 01 | NY | GHI/HMO | OTHER | 5227684 | 01 | NY | AETNA | OTHER | 10000771 | 01 | NY | CDPHP | OTHER | 200058 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 550721 | 01 | NY | EMPIRE BC | OTHER | 060925000046 | 01 | NY | FIDELIS | OTHER | 26102 | 01 | NY | MVP | OTHER |