Healthcare Provider Details

I. General information

NPI: 1508263617
Provider Name (Legal Business Name): RACHEL GLANTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 QUAKER LN S
WEST HARTFORD CT
06110-1026
US

IV. Provider business mailing address

68 BRETTON RD
WEST HARTFORD CT
06119-1208
US

V. Phone/Fax

Practice location:
  • Phone: 860-232-2010
  • Fax: 860-232-2011
Mailing address:
  • Phone: 860-463-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3969
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00352200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: