Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 61129 | CT |
N | 207XS0117X | Orthopaedic Spine Surgeon | 61129 | CT |
NPI | 1134488331 |
---|---|
Provider Name | Dr. Glenn Scott Russo |
First Address | Hamden, CT 06518-3209 |
Second Address | Hamden, CT 06518-3209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2012 |
Last Update Date | 23/07/2021 |