Healthcare Provider Details

I. General information

NPI: 1457302820
Provider Name (Legal Business Name): GLENN FLORES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONNECTICUT CHILDREN'S SPECIALTY GROUP 282 WASHINGTON STREET
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

CONNECTICUT CHILDREN'S SPECIALTY GROUP 60 HARTLAND STREET - CBO
EAST HARTFORD CT
06108-3250
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-7250
  • Fax: 860-837-7251
Mailing address:
  • Phone: 860-837-5602
  • Fax: 860-837-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45006
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33074
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: