Provider Demographics
NPI:1922027259
Name:RICH, GLENN M (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:M
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15 CORPORATE DR
Mailing Address - Street 2:SUITE 2-1
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1351
Mailing Address - Country:US
Mailing Address - Phone:203-452-2446
Mailing Address - Fax:203-452-2424
Practice Address - Street 1:15 CORPORATE DR
Practice Address - Street 2:SUITE 2-1
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1351
Practice Address - Country:US
Practice Address - Phone:203-452-2446
Practice Address - Fax:203-452-2424
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT032294207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010032294CT03OtherANTHEM BLUE CROSS BLUE SH
CT110086147OtherRAILROAD MEDICARE PTAN
CT492617OtherAETNA
CT0284725OtherCIGNA HEALTHCARE OF CT
CT061394494OtherUNITED HEALTHCARE
CT532294OtherCONNECTICARE, INC & AFFIL
COCU8879OtherHEALTHNET
CTZP329OtherOXFORD HEALTH PLANS
CT001322940Medicaid
CTZP329OtherOXFORD HEALTH PLANS
CT110005252Medicare ID - Type Unspecified