Provider Demographics
NPI:1740484187
Name:GROSS, STEWART CORY (MD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:CORY
Last Name:GROSS
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 1:2660 MAIN ST STE 311
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5301
Mailing Address - Country:US
Mailing Address - Phone:203-367-4008
Mailing Address - Fax:203-368-0292
Practice Address - Street 1:2660 MAIN ST STE 311
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5301
Practice Address - Country:US
Practice Address - Phone:203-367-4008
Practice Address - Fax:203-368-0292
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT299102086S0105X
CT029910207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTZS224OtherOXFORD
CT001125OtherHEALTHNET
CT001299107Medicaid
CT010029910CT01OtherBLUE CROSS BLUE SHIELD
CT4351331OtherAETNA US HEALTH CARE
CTZS224OtherOXFORD
CT001299107Medicaid