Provider Demographics
NPI:1104837483
Name:TAYLOR, STACY J (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:893 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2293
Mailing Address - Country:US
Mailing Address - Phone:860-528-2138
Mailing Address - Fax:860-528-0514
Practice Address - Street 1:333 KENNEDY DR
Practice Address - Street 2:SUITE L-201
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3060
Practice Address - Country:US
Practice Address - Phone:860-482-0261
Practice Address - Fax:860-482-6301
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT040104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH64024Medicare UPIN