Provider Demographics
NPI:1275518771
Name:HUOT, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:HUOT
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 1:333 CEDAR STREET
Mailing Address - Street 2:LMP 1074
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8033
Mailing Address - Country:US
Mailing Address - Phone:203-785-5644
Mailing Address - Fax:203-785-7030
Practice Address - Street 1:789 HOWARD AVENUE
Practice Address - Street 2:DANA BUILDING 3RD FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-8056
Practice Address - Country:US
Practice Address - Phone:203-785-4629
Practice Address - Fax:203-785-7030
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028367207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001283671Medicaid
E74777Medicare UPIN
CT110004242Medicare ID - Type Unspecified