Provider Demographics
NPI:1215968482
Name:GLUCKSMAN, MYRON LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:MYRON
Middle Name:LAWRENCE
Last Name:GLUCKSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 MARCHANT RD
Mailing Address - Street 2:
Mailing Address - City:WEST REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1823
Mailing Address - Country:US
Mailing Address - Phone:203-938-1188
Mailing Address - Fax:
Practice Address - Street 1:68 MARCHANT RD
Practice Address - Street 2:
Practice Address - City:WEST REDDING
Practice Address - State:CT
Practice Address - Zip Code:06896-1823
Practice Address - Country:US
Practice Address - Phone:203-938-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT146182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83688Medicare UPIN