Provider Demographics
NPI:1881335248
Name:LONTOK, STEPHANIE ANN S (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE ANN
Middle Name:S
Last Name:LONTOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE ANN
Other - Middle Name:BRINGAS
Other - Last Name:SEVILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-1921
Mailing Address - Country:US
Mailing Address - Phone:860-679-2147
Mailing Address - Fax:860-679-4624
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-1900
Practice Address - Country:US
Practice Address - Phone:860-679-4888
Practice Address - Fax:860-679-0134
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program