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General NPI Number Information
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NPI Number | 1376503003
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Entity Type | Individual
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Provider Name | RICHARD DENNIS GLISSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2006
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 124 HEBRON AVE STE 1B
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City | GLASTONBURY
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State | CT
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Zip | 06033
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Country | US
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Telephone | 860-633-8806
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Fax | 860-657-3788
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Provider Business Mailing Address
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Address Line | PO BOX 230
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City | GLASTONBURY
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State | CT
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Zip | 06033-0230
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Country | US
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Telephone | 860-633-8806
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Fax | 860-657-3788
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OS21704
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 038819
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License Number State | CT
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