Provider Demographics
NPI:1609800606
Name:STAMFORD NEPHROLOGY, P.C.
Entity Type:Organization
Organization Name:STAMFORD NEPHROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-324-7666
Mailing Address - Street 1:30 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4550
Mailing Address - Country:US
Mailing Address - Phone:203-324-7666
Mailing Address - Fax:
Practice Address - Street 1:30 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4550
Practice Address - Country:US
Practice Address - Phone:203-324-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000129151Medicaid
CT0012891040Medicaid
CT001394692Medicaid
CTH01349Medicare UPIN
CT0012891040Medicaid
CT000129151Medicaid
CTE53268Medicare UPIN
CT110005259Medicare ID - Type Unspecified
CT110008325Medicare ID - Type Unspecified