Provider Demographics
NPI:1972545689
Name:GALAN, ELIZABETH B (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:B
Last Name:GALAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 NEW LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6414
Mailing Address - Country:US
Mailing Address - Phone:860-482-6513
Mailing Address - Fax:860-489-7250
Practice Address - Street 1:95 NEW LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6414
Practice Address - Country:US
Practice Address - Phone:860-482-6513
Practice Address - Fax:860-489-7250
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001391169Medicaid
CT30683OtherSTATE CONTR. SUBST. REG.
CT039116OtherSTATE LICENSE NUMBER
CTBG7206661OtherDEA NUMBER
CT001391169Medicaid
CT039116OtherSTATE LICENSE NUMBER