Christopher Glen Ilacqua, M.D.
Physical Medicine & Rehabilitation in Southbridge, MA. Individual provider (NPI-1).
NPI number1528291127
StatusActive
Last updated in NPPESApr 15, 2024
Details
- NPI
- 1528291127
- Entity type
- Individual (NPI-1)
- Name
- Mr. Christopher Glen Ilacqua
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 29, 2009
- Certification date
- Apr 15, 2024
- Last updated
- Apr 15, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | 1017464 | MA | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 2015 | MA | |
| 208100000X | Physical Medicine & Rehabilitation | MD467051 | PA |
Practice location
100 South StSouthbridge, MA 01550-4051
Phone 508-909-8590 · Fax 508-909-8589
Mailing address
Po Box 415348Boston, MA 02241-5348
Other practice locations
123 Summer Street
Worcester, MA 01608
Worcester, MA 01608
Phone 508-363-6208
3401 N Broad St Lowr Level
Philadelphia, PA 19140-5103
Philadelphia, PA 19140-5103
Phone 215-707-7020
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