B .Glenn Blair DPM P.C.

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

000419 Issued in CT

Legal business name

B .GLENN BLAIR DPM P.C.

Practice address

375 Bridgeport Ave
Shelton, CT 06484-3844

Phone

(203) 929-5559

Fax

(203) 929-5277

NPI assigned

Dec 18, 2007

Last updated

Apr 2, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Julie M Russell

Title

Office Manager

Phone

(203) 929-5559

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ballard Glenn Blair, D.P.M

  • Primary Podiatric Medicine Podiatrist
  • Shelton, CT
  • NPI 1356350201
  Medicare reassignment NPD
• Maureen O'Donnell Sharnick, D.M.D.

  • General Practice Dentistry
  • Shelton, CT
  • NPI 1871646836
  NPD (past)
• Scott Waller, M.D.

  • Orthopaedic Surgery Physician
  • Shelton, CT
  • NPI 1720011547
  NPD (past)
• Rohini Moholkar, PT

  • Physical Therapist
  • Worcester, MA
  • NPI 1760581219
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333324800000",
    "number": "1306020938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 BRIDGEPORT AVE",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064843844",
            "telephone_number": "203-929-5559",
            "fax_number": "203-929-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 BRIDGEPORT AVE",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064843844",
            "telephone_number": "203-929-5559",
            "fax_number": "203-929-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B .GLENN BLAIR DPM P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2012-04-02",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "203-929-5559",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CT",
            "license": "CT000419",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CT",
            "license": "000419",
            "primary": true
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Radiology",
            "state": "CT",
            "license": "000419",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "CT",
            "license": "000419",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004176815",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Piotr Waldemar Baginski, MD
• Gerald Patrick Bailey, M.D.

• Primary Podiatric Medicine Podiatrist in Shelton, CT
• Providers in Shelton, CT by specialty
• Primary Podiatric Medicine Podiatrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.