Provider Demographics
NPI:1861450538
Name:BRIGGS, STEPHEN T
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:T
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CASE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2214
Mailing Address - Country:US
Mailing Address - Phone:860-886-2461
Mailing Address - Fax:860-887-8530
Practice Address - Street 1:17 CASE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2214
Practice Address - Country:US
Practice Address - Phone:860-886-2461
Practice Address - Fax:860-887-8530
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034494174400000X
CT34494207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001344944Medicaid
CT160001304Medicare ID - Type Unspecified
CT001344944Medicaid