Provider Demographics
NPI:1023089489
Name:O'CONNOR, STEFAN S (MD)
Entity type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:S
Last Name:O'CONNOR
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 1:1111 DARDEL RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2711
Mailing Address - Country:US
Mailing Address - Phone:302-478-5908
Mailing Address - Fax:
Practice Address - Street 1:2055 LIMESTONE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5536
Practice Address - Country:US
Practice Address - Phone:302-992-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003896207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000415101Medicaid
DE510390465OtherCIGNA
DE0000415101OtherDELAWARE PHYSICIANS CARE
DE4344682OtherAETNA
DE510390465OtherBLUE CROSS BLUE SHIELD
DE0560630000OtherKEYSTONE/AMERIHEALTH
DEF27387Medicare UPIN
DE0000415101OtherDELAWARE PHYSICIANS CARE
DE0000415101Medicaid