Provider Demographics
NPI:1366461477
Name:WIEBER, STASIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:STASIA
Middle Name:J
Last Name:WIEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:501 KINGS HWY E
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4867
Mailing Address - Country:US
Mailing Address - Phone:203-610-6300
Mailing Address - Fax:203-610-6347
Practice Address - Street 1:501 KINGS HWY E
Practice Address - Street 2:SUITE 204
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4867
Practice Address - Country:US
Practice Address - Phone:203-610-6300
Practice Address - Fax:203-610-6347
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY199161207RP1001X
CT044709207RS0012X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0014447095Medicaid
G54052Medicare UPIN
CT0014447095Medicaid