Individual
DR. STEPHEN GLENN VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21 MONTAUK AVE, NEW LONDON, CT 06320-4906
(860) 439-6400
(860) 271-4797
Mailing address
PO BOX 390, NEW LONDON, CT 06320-0390
(860) 271-4700
(860) 271-4797
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
051723
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200821230
—
IN
05
—
64076672
—
KY
Enumeration date
02/03/2006
Last updated
02/24/2016
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