Provider Demographics
NPI:1093904211
Name:STAMFORD INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:STAMFORD INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMBROS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIDERIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-348-1550
Mailing Address - Street 1:1351 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2419
Mailing Address - Country:US
Mailing Address - Phone:203-322-9472
Mailing Address - Fax:203-322-1264
Practice Address - Street 1:1351 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2419
Practice Address - Country:US
Practice Address - Phone:203-322-9472
Practice Address - Fax:203-322-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1086537Medicaid
CT1086537Medicaid
CTC000871Medicare UPIN