Provider Demographics
NPI:1326142332
Name:PHELAN, STEPHEN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:PHELAN
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 1:91 VOLUNTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1366
Mailing Address - Country:US
Mailing Address - Phone:860-599-5477
Mailing Address - Fax:860-865-2389
Practice Address - Street 1:91 VOLUNTOWN RD
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1366
Practice Address - Country:US
Practice Address - Phone:860-599-5477
Practice Address - Fax:860-865-2389
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12629207R00000X
NY242245-1207R00000X
CT046242207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU400125774Medicare PIN
NHI29592Medicare UPIN
NHPHRE8244Medicare ID - Type Unspecified
CTD400086225Medicare PIN