Individual
GLENN S BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
789 CENTRAL AVE, WENTWORTH DOUGLASS HOSPITAL, DOVER, NH 03820
(603) 749-7246
(603) 749-2453
Mailing address
3998 FAIR RIDGE DR, STE 300, FAIRFAX, VA 22033-2921
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
9896
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30220036
—
NH
Enumeration date
01/05/2006
Last updated
03/06/2015
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