Provider Demographics
NPI:1700841368
Name:GLASSMAN, STANLEY ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ARTHUR
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NORTHWESTERN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3480
Mailing Address - Country:US
Mailing Address - Phone:860-696-4690
Mailing Address - Fax:860-696-4695
Practice Address - Street 1:2 NORTHWESTERN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3480
Practice Address - Country:US
Practice Address - Phone:860-696-4690
Practice Address - Fax:860-696-4695
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001379579Medicaid
CT110009242Medicare UPIN
CT001379579Medicaid