Provider Demographics
NPI:1801822473
Name:GO, STEPHEN D (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:220 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-7204
Mailing Address - Country:US
Mailing Address - Phone:860-489-7314
Mailing Address - Fax:860-489-7213
Practice Address - Street 1:220 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-7204
Practice Address - Country:US
Practice Address - Phone:860-489-7314
Practice Address - Fax:860-489-7213
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0368122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001368126Medicaid
CT26551OtherDEPT OF CONSUMER PROTECT
G74612Medicare UPIN