GLEN D BLOMSTROM (Credential# 1134496) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2020. The license expiration date date is March 31, 2021. The license status is ACTIVE.
GLEN D BLOMSTROM is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.051665. The credential type is physician/surgeon. The effective date is April 1, 2020. The expiration date is March 31, 2021. The business address is 31 Smiths Point Road, Milford, CT 06460. The current status is active.
Licensee Name | GLEN D BLOMSTROM |
Credential ID | 1134496 |
Credential Number | 1.051665 |
Credential Type | Physician/Surgeon |
Business Address |
31 Smiths Point Road Milford CT 06460 |
Business Type | INDIVIDUAL |
Status | ACTIVE - CURRENT |
Active | 1 |
Issue Date | 2013-03-01 |
Effective Date | 2020-04-01 |
Expiration Date | 2021-03-31 |
Refresh Date | 2020-01-13 |
ID | Credential Code | Credential Type | Issue | Term | Status |
---|---|---|---|---|---|
895546 | CSP.0046644 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2010-09-23 | 2019-03-01 - 2021-02-28 | ACTIVE |
865702 | 70.931672 | Emergency Medical Technician | 1993-08-01 | 2004-10-19 - 2007-09-30 | INACTIVE |
878150 | 71.990055 | Advanced Emergency Medical Technician | 1999-05-01 | - 2001-09-30 | INACTIVE |
Street Address | 31 Smiths Point Road |
City | Milford |
State | CT |
Zip Code | 06460 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Milford Council On Aging | 9 Jepson Drive, Milford, CT 06460 | Public Charity | 2019-06-01 ~ 2020-05-31 |
James J Melanson | 319 Welch's Point Road, Milford, CT 06460 | Optician | 2020-08-01 ~ 2021-07-31 |
Robert J Colum | 61 Melba St, Milford, CT 06460 | Professional Engineer | 2020-06-16 ~ 2021-01-31 |
James E Phillips | 88 Noble Ave, Milford, CT 06460 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
Douglas H Gruber | 33 Lincoln Ave, Milford, CT 06460 | Licensed Alcohol and Drug Counselor | 2020-06-01 ~ 2021-05-31 |
Christine D Rettig | 1 Schooner Lane, Milford, CT 06460 | Physical Therapist | 2020-07-01 ~ 2021-06-30 |
Golden Dragon Inc | 262 D Quarry Rd, Mildord, CT 06460 | Food Warehouse | ~ |
Kelli-ann Armstrong | 50 Cherry Street, Milford, CT 06460 | Optometrist | 2020-07-01 ~ 2021-06-30 |
Mary C Cohen | 9 Stevens Street, Milford, CT 06460 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
Nicole Wilson | 26 Daggett Street, Milford, CT 06460 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
Find all Licenses in zip 06460 |
City | Milford |
Zip Code | 06460 |
License Type | Physician/Surgeon |
License Type + County | Physician/Surgeon + Milford |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Alpesh A Patel | 2315 Glen St., Glen Cove, NY 11542 | Physician/surgeon | 2008-04-08 ~ 2008-06-30 |
Raymond G Haddad | 5000 Harvest Glen Court, Glen Allen, VA 23059 | Physician/surgeon | 2011-07-01 ~ 2012-06-30 |
Himati Parag Patel | 4565 Paxton Glen Dr, Glen Allen, VA 23059-7168 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Glen Lovejoy Md | Colebrook, CT 06021 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
Salvatore Iannotti | 19 Oak Glen Dr, Huntington, CT 06418 | Physician/surgeon | 1996-11-13 ~ 1998-01-31 |
Glen D Seidman Md | 65 Kane St, W Hartford, CT 06119 | Physician/surgeon | 1996-03-14 ~ 1997-04-30 |
Philip T Peverada | P.o. Box 185, Glen Cove, ME 04846 | Physician/surgeon | ~ 1994-12-31 |
Janardhan R Jagini | 3 Glen Ln, Ellington, CT 06029 | Physician/surgeon | 2019-08-01 ~ 2020-07-31 |
Steven V Krasnica | 28 Glen Rd, Greenwich, CT 06830-4632 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
Nel Go | 856 Glen Haven Circle, Petoskey, MI 49770 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
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Data Provider | Connecticut Department of Consumer Protection |
Jurisdiction | Connecticut |
Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).