Provider Demographics
NPI:1376529818
Name:STAHL, KENT I (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:I
Last Name:STAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1025 SILAS DEANE HWY
Mailing Address - Street 2:HARTFORD MEDICAL GROUP PC
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109
Mailing Address - Country:US
Mailing Address - Phone:860-696-2400
Mailing Address - Fax:860-696-2411
Practice Address - Street 1:1025 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4229
Practice Address - Country:US
Practice Address - Phone:860-696-2400
Practice Address - Fax:860-696-2410
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT022955207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001229558Medicaid
D98105Medicare UPIN
CT001229558Medicaid
700004956Medicare PIN