Basic Information
| Provider Information | |||||||||
| NPI: | 1528005675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAIR | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2989 DIXWELL AVE | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032483013 | ||||||||
| FaxNumber: | 2032482878 | ||||||||
| Practice Location | |||||||||
| Address1: | 677 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHESHIRE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064103158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032722248 | ||||||||
| FaxNumber: | 2032724470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 023081 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00092188 | 01 | CT | RAILROAD MEDICARE | OTHER | P2734634 | 01 | CT | OXFORD | OTHER | 2988614 | 01 | CT | AETNA | OTHER | 010023081CT14 | 01 | CT | BLUE CROSS | OTHER | 0Q1864 | 01 | CT | HEALTH NET | OTHER | 230810 | 01 | CT | CONNECTICARE | OTHER |