Provider Demographics
NPI:1740399302
Name:CALLE, STUART C (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:C
Last Name:CALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:66 CEDAR ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2655
Mailing Address - Country:US
Mailing Address - Phone:860-436-3226
Mailing Address - Fax:860-436-3229
Practice Address - Street 1:66 CEDAR ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2655
Practice Address - Country:US
Practice Address - Phone:860-436-3226
Practice Address - Fax:860-436-3229
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036038207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT036038OtherDEPT OF PUBLIC HEALTH LIC
NYH62415Medicare UPIN