Provider Demographics
NPI:1841365681
Name:GART, GLENN STANTON (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:STANTON
Last Name:GART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:255 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-589-1405
Mailing Address - Fax:860-589-9030
Practice Address - Street 1:72 PINE ST UNIT 3
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6960
Practice Address - Country:US
Practice Address - Phone:860-589-1405
Practice Address - Fax:860-589-9030
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CTCT033528207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001335282Medicaid