Blair, Ballard Glenn

Blair, Ballard Glenn is an sole proprietor health care provider with primary practice located at 375 Bridgeport Ave , Shelton CT 06484. He recently has 4 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine, Podiatric Medicine & Surgery Service Providers / Radiology, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Podiatrist. Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine is his primary health care specialty. Blair, Ballard Glenn can be contacted via phone (203) 929-5559.

Contact Information

Primary practice address
375 Bridgeport Ave Shelton CT 06484
Phone: (203) 929-5559
Fax: (203) 929-5277
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine 213EP1101X 00419 Connecticut
Podiatric Medicine & Surgery Service Providers / Radiology 213ER0200X 00419 Connecticut
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 00419 Connecticut
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X CT000419 Connecticut

Profile Details

NPI number 1356350201
LBN Legal business name Blair, Ballard Glenn
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 7th, 2006
Last updated Sep 4th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356350201 NPPES
Connecticut MEDICAID 004070918

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