Individual
GLENN G. FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
115 CASS AVE, LANDMARK MEDICAL CENTER, WOONSOCKET, RI 02895
(401) 766-3428
(401) 767-1633
Mailing address
115 CASS AVE, LANDMARK MEDICAL CENTER, WOONSOCKET, RI 02895
(401) 766-3428
(401) 767-1633
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD07281
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9006604
—
RI
Enumeration date
11/23/2005
Last updated
07/09/2007
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