Provider Demographics
NPI:1457302820
Name:FLORES, GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONNECTICUT CHILDREN'S SPECIALTY GROUP
Mailing Address - Street 2:60 HARTLAND STREET - CBO
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3250
Mailing Address - Country:US
Mailing Address - Phone:860-837-5602
Mailing Address - Fax:860-837-5613
Practice Address - Street 1:CONNECTICUT CHILDREN'S SPECIALTY GROUP
Practice Address - Street 2:282 WASHINGTON STREET
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-837-7250
Practice Address - Fax:860-837-7251
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45006208000000X
CT33074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1457302820Medicaid
WI34250700Medicaid
008000261BOtherHUMANA
CT1457302820Medicaid
F36431Medicare UPIN