Provider Demographics
NPI:1013901602
Name:STAW, IGAL (MD)
Entity Type:Individual
Prefix:DR
First Name:IGAL
Middle Name:
Last Name:STAW
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 1:2000 POST RD
Mailing Address - Street 2:STE 202
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5730
Mailing Address - Country:US
Mailing Address - Phone:203-853-1919
Mailing Address - Fax:203-855-9002
Practice Address - Street 1:2000 POST RD
Practice Address - Street 2:STE 202
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5730
Practice Address - Country:US
Practice Address - Phone:203-853-1919
Practice Address - Fax:203-855-9002
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2019-04-28
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
CT020108207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB38323Medicare UPIN