Individual
MARY A GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
495 GOLD STAR HWY, SUITE 120, GROTON, CT 06340-6228
(860) 449-8882
(860) 449-9195
Mailing address
495 GOLD STAR HWY, SUITE 120, GROTON, CT 06340-6228
(860) 449-8882
(860) 449-9195
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
032910
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001329102
—
CT
01
—
010032910CT-04
BLUE CROSS BLUE SHIELD
—
01
—
08211695-009
CIGNA
—
01
—
2V6459
HEALTH NET
—
01
—
329100
CONNECTICARE
—
01
—
4351240
AETNA
—
01
—
P766722
OXFORD
—
Enumeration date
12/11/2006
Last updated
07/08/2007
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