Provider Demographics
NPI:1205877081
Name:GLASSMAN, LAURIE CARYN (MD, FAAP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:CARYN
Last Name:GLASSMAN
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:CARYN
Other - Last Name:GLASSMAN-WISNEWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:21 COACHMAN LN
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3256
Mailing Address - Country:US
Mailing Address - Phone:203-589-7758
Mailing Address - Fax:
Practice Address - Street 1:299 WASHINGTON AVE STE LL
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3039
Practice Address - Country:US
Practice Address - Phone:203-288-4288
Practice Address - Fax:855-414-4010
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034744208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1347443Medicaid