Provider Demographics
NPI:1912059221
Name:TEPPER, STEWART J (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:J
Last Name:TEPPER
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 1:30 BUXTON FARM RD STE 230
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1206
Mailing Address - Country:US
Mailing Address - Phone:203-914-1900
Mailing Address - Fax:
Practice Address - Street 1:30 BUXTON FARM RD STE 230
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1206
Practice Address - Country:US
Practice Address - Phone:203-914-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT382972084N0400X
NH173552084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2830548Medicaid
OH2830548Medicaid
OH7383291Medicare PIN