Basic Information
| Provider Information | |||||||||
| NPI: | 1124283601 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STAMFORD HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 SHELBURNE RD | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069023628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032767467 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 SHELBURNE RD | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069023628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032767467 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2008 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | PREMDASS | ||||||||
| AuthorizedOfficialFirstName: | CHERRYL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PGY-1 SURGERY | ||||||||
| AuthorizedOfficialTelephone: | 2032767470 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | AS2383278 | CT | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.