Provider Demographics
NPI:1275626673
Name:STAMFORD GYNECOLOGY PC
Entity Type:Organization
Organization Name:STAMFORD GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOODHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-359-3340
Mailing Address - Street 1:70 MILL RIVER ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-359-3340
Mailing Address - Fax:203-359-4515
Practice Address - Street 1:70 MILL RIVER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-359-3340
Practice Address - Fax:203-359-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9645207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
774778OtherCONNECTICARE
CT0000025OtherSELECT PRO
022258OtherHEALTHNET
010009645CT01OtherANTHEM
ZP286OtherOXFORD
2152738OtherAETNA
022258OtherHEALTHNET
774778OtherCONNECTICARE
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