Provider Demographics
NPI:1275585705
Name:ROWE, STEPHANIE J (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:ROWE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5246
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-0246
Mailing Address - Country:US
Mailing Address - Phone:203-384-3873
Mailing Address - Fax:203-384-3829
Practice Address - Street 1:887 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4621
Practice Address - Country:US
Practice Address - Phone:203-225-6020
Practice Address - Fax:203-384-3829
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001004259Medicaid
CT001004259Medicaid
CTG09419Medicare UPIN