Healthcare Provider Details

I. General information

NPI: 1134045131
Provider Name (Legal Business Name): BRIANNA RAE MCGLONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S MAIN ST
MIDDLETOWN CT
06457-3724
US

IV. Provider business mailing address

145 S MAIN ST
MIDDLETOWN CT
06457-3724
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-0720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number158448
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: