Provider Demographics
NPI:1295777613
Name:NERENSTONE, STACY R (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:R
Last Name:NERENSTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RETREAT AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2527
Mailing Address - Country:US
Mailing Address - Phone:860-249-6291
Mailing Address - Fax:860-728-0151
Practice Address - Street 1:85 RETREAT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2527
Practice Address - Country:US
Practice Address - Phone:860-249-6291
Practice Address - Fax:860-728-0151
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029763207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001297630Medicaid
CTE56775Medicare UPIN
CT830000020Medicare ID - Type Unspecified