Provider Demographics
NPI:1346278512
Name:WIDMAN, STEPHEN CONNER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CONNER
Last Name:WIDMAN
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 1:455 CHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3352
Mailing Address - Country:US
Mailing Address - Phone:203-573-1435
Mailing Address - Fax:203-755-7433
Practice Address - Street 1:455 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3352
Practice Address - Country:US
Practice Address - Phone:203-573-1435
Practice Address - Fax:203-755-7433
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030739207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0R0351OtherHEALTH NET OF NORTHEAST
CT001307398Medicaid
CT010130739OtherCIGNA HEALTH PLANS
CTP381955OtherOXFORD HEALTH PLANS
CT110036141OtherRAILROAD MEDICARE
CT030739OtherCONNECTICARE
CT4127784OtherAETNA HEALTH LANS
CT1346278512Medicaid
CT010030739CT01OtherANTHEM BC & BS
CT4127784OtherAETNA HEALTH LANS
CTB85396Medicare UPIN
CTP381955OtherOXFORD HEALTH PLANS