Provider Demographics
NPI:1326290826
Name:DAVIS, STEPHEN LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LAWRENCE
Last Name:DAVIS
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 1:74 BATTERSON PARK RD STE 107
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2565
Mailing Address - Country:US
Mailing Address - Phone:860-549-8276
Mailing Address - Fax:
Practice Address - Street 1:31 SEYMOUR ST STE 100
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5521
Practice Address - Country:US
Practice Address - Phone:860-549-3210
Practice Address - Fax:860-247-3803
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051884207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery