Provider Demographics
NPI:1366478315
Name:POSSICK, STANLEY GERALD (MD)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:GERALD
Last Name:POSSICK
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 1:303 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-7204
Mailing Address - Country:US
Mailing Address - Phone:203-782-1511
Mailing Address - Fax:203-389-0814
Practice Address - Street 1:303 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-7204
Practice Address - Country:US
Practice Address - Phone:203-782-1511
Practice Address - Fax:203-389-0814
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0171042084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE27058Medicare UPIN
260000782Medicare PIN