BALLARD GLENN BLAIR (NPI# 1356350201) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356350201 |
| Entity Type | Individual |
| Full Name | BALLARD GLENN BLAIR |
| Other Name | B. GLENN BLAIR |
| Credential | D.P.M |
| Practice Address |
375 Bridgeport Ave Shelton CT 06484 |
| Practice Telephone | 2039295559 |
| Practice Fax Number | 2039295277 |
| Mailing Telephone | 2039295559 |
| Mailing Fax Number | 2039295277 |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2013-09-04 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | CT000419 | CT | Podiatric Medicine & Surgery Service Providers |
| Y | 213EP1101X |
Podiatrist Specialization: Primary Podiatric Medicine |
00419 | CT | Podiatric Medicine & Surgery Service Providers |
| N | 213ER0200X |
Podiatrist Specialization: Radiology |
00419 | CT | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
00419 | CT | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004070918 | 05 |
| Street Address |
375 BRIDGEPORT AVE |
| City | SHELTON |
| State | CT |
| Zip Code | 06484 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306020938 | B .glenn Blair Dpm P.C. | Durable Medical Equipment & Medical Supplies | 375 Bridgeport Ave, Shelton, CT 06484-3844 | 2007-12-18 |
| 1770704736 | John Gell | Dentist | 375 Bridgeport Ave, Shelton, CT 06484-3844 | 2007-05-01 |
| 1871646836 | Maureen O'donnell Sharnick | Dentist | 375 Bridgeport Ave, Shelton, CT 06484-3844 | 2007-01-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255949517 | Judy Ports | Speech-Language Pathologist | 100 Bear Sawmill Rd, Shelton, CT 06484 | 2020-07-22 |
| 1144793340 | Theodore N. Zengou | Pharmacist | 875 Bridgeport Av., Shelton, CT 06484 | 2019-01-10 |
| 1194215046 | Brightview Shelton LLC | Alzheimer Center (Dementia Center) | 30 Beard Sawmill Road, Shelton, CT 06484 | 2018-05-16 |
| 1477071264 | Emily Buccigross | Specialist/Technologist | 941 Constitution Blvd N, Shelton, CT 06484 | 2017-09-01 |
| 1134649643 | Margaret Grace Ferrara | Dentist | 4 Corporate Dr Ste 383, Shelton, CT 06484 | 2017-06-26 |
| 1376092007 | Qmg3 LLC | Family Medicine | 405 Bridgeport Avenue, Shelton, CT 06484 | 2016-09-22 |
| 1215316427 | Marcella N. Sancho, Lcsw, LLC | Social Worker | 4 Research Drive, Suite 402, Shelton, CT 06484 | 2015-05-20 |
| 1578987483 | Lisa Sych | Speech-Language Pathologist | 584 Long Hill Avenue- Bishop Wicke Health Center, Shelton, CT 06484 | 2014-02-12 |
| 1073936324 | Jeanne M. Kellogg | Occupational Therapy Assistant | 36 Fairlane Dr., Shelton, CT 06484 | 2014-01-22 |
| 1851724454 | Brittany Steiner | Behavioral Analyst | 26 Pound Ridge Ave, Shelton, CT 06484 | 2013-08-19 |
| Find all providers in zip 06484 | ||||
| Taxonomy Code | 213EP1101X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Primary Podiatric Medicine |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609354372 | Riverside Podiatry,llc | Podiatrist | 11 Westridge Dr, Avon, CT 06001-3648 | 2018-08-03 |
| 1104236199 | Sean Wayne Lazarus D.p.m. LLC | Podiatrist | 764 Campelle Ave, Unitg, West Haven, CT 06516-3786 | 2014-04-30 |
| 1588957872 | Mt Podiatry, LLC | Podiatrist | 1021 Asylum Ave, Apt 407, Hartford, CT 06105-2436 | 2011-05-19 |
| 1497817118 | Michael Connor | Podiatrist | 27 Danbury Rd Fl 3, Wilton, CT 06897-4405 | 2006-12-16 |
| 1629012661 | Thomas M Domanick | Podiatrist | 1825 Barnum Ave, Stratford, CT 06614-5333 | 2006-06-16 |
| 1659320711 | Todd Allen Bell | Podiatrist | 57 Jolley Dr, Unit A, Bloomfield, CT 06002-3062 | 2006-05-08 |
| 1114928074 | Michael Jospeh Ackley | Podiatrist | 714 S Main St, Cheshire, CT 06410-3448 | 2005-08-02 |
| 1831194042 | Karana Marie Pierre | Podiatrist | 471 Barnum Ave, Bridgeport, CT 06608-2409 | 2005-06-15 |
| 1205479243 | Nili T Harpaz | Podiatrist | 309 Seaside Ave, Milford, CT 06460-4625 | 2019-10-22 |
| 1205489077 | St Vincents Multispecialty Group Inc | Podiatrist | 2409 Main St, Bridgeport, CT 06606-5324 | 2019-07-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.