Basic Information
| Provider Information | |||||||||
| NPI: | 1871753509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENSON | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 KANE ST | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061192110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605236421 | ||||||||
| FaxNumber: | 8605233701 | ||||||||
| Practice Location | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | GENERAL SURGERY DEPT. | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060306227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606793540 | ||||||||
| FaxNumber: | 8606791390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2008 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 049958 | CT | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 208600000X | 049958 | CT | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.