Provider Demographics
NPI:1407947062
Name:STEWART C GROSS MD
Entity Type:Organization
Organization Name:STEWART C GROSS MD
Other - Org Name:HAND SURGERY OF SOUTHERN CONNECTICUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:C
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-367-4008
Mailing Address - Street 1:2660 MAIN STREET
Mailing Address - Street 2:S 311
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-367-4008
Mailing Address - Fax:203-368-0292
Practice Address - Street 1:2660 MAIN STREET
Practice Address - Street 2:S 311
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-367-4008
Practice Address - Fax:203-368-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT299102086S0105X
CT0025752086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D80877Medicare UPIN
CT0536110001Medicare NSC