Provider Demographics
NPI:1538144035
Name:SOMLO, STEFAN (MD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:SOMLO
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 1:333 CEDAR ST
Mailing Address - Street 2:BB 114
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-785-4184
Mailing Address - Fax:203-785-7068
Practice Address - Street 1:333 CEDAR ST
Practice Address - Street 2:BB 114
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-785-4184
Practice Address - Fax:203-785-7068
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028167207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001281675Medicaid
E55218Medicare UPIN
CT110007557Medicare ID - Type Unspecified