Provider Demographics
NPI:1740461730
Name:GLASTONBURY FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:GLASTONBURY FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMTU
Authorized Official - Middle Name:
Authorized Official - Last Name:KARRENBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-633-5115
Mailing Address - Street 1:131 NEW LONDON TPKE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2246
Mailing Address - Country:US
Mailing Address - Phone:860-633-5115
Mailing Address - Fax:860-633-5125
Practice Address - Street 1:131 NEW LONDON TPKE
Practice Address - Street 2:SUITE 322
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2246
Practice Address - Country:US
Practice Address - Phone:860-633-5115
Practice Address - Fax:860-633-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-18
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty