Provider Demographics
NPI:1770725384
Name:ALICIA STANTON MD, PA
Entity type:Organization
Organization Name:ALICIA STANTON MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-959-2758
Mailing Address - Street 1:21 WOODLAND ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4318
Mailing Address - Country:US
Mailing Address - Phone:800-959-2758
Mailing Address - Fax:860-432-5876
Practice Address - Street 1:195 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4858
Practice Address - Country:US
Practice Address - Phone:800-959-2758
Practice Address - Fax:860-432-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033768174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty