Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 039159 | CT |
Y | 111NI0900X | Internist | 039159 | CT |
N | 207RG0300X | Geriatric Medicine | 039159 | CT |
N | 207RH0002X | Hospice and Palliative Medicine | 039159 | CT |
NPI | 1134101306 |
---|---|
Provider Name | Dr. Glendo Tangarorang |
First Address | Rocky Hill, CT 06067-2313 |
Second Address | Hartford, CT 06106-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 03/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001391599 | (05) | CT |
H33084 | (02) |