Provider Demographics
NPI:1114913894
Name:WALDSTREICHER, STUART (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:WALDSTREICHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 LONG RIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1252
Mailing Address - Country:US
Mailing Address - Phone:203-967-2100
Mailing Address - Fax:203-967-4872
Practice Address - Street 1:778 LONG RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1265
Practice Address - Country:US
Practice Address - Phone:203-967-2100
Practice Address - Fax:203-967-4872
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT02797207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010027907C501OtherBC/BS ID #
014929OtherCT CARE ID #
020184OtherHEALTHNET ID #
061246885OtherUNITED HEALTHCARE ID #
25046OtherOXFORD ID #
B84104Medicare UPIN