MEDICARE: STAMFORD HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	0059	CT
2	363LA2200X	Adult Health Nurse Practitioner	0059	CT
3	282N00000X	General Acute Care Hospital	0059	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C00013	OTHER	CT	MEDICARE PART B PROVIDER

General Provider Information

NPI Number	:	1356331425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAMFORD HOSPITAL

Provider Business Mailing Address
First Line	:	1 HOSPITAL PLZ
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-3602
Country	:	US
Telephone Number	:	203-276-1000
Fax Number	:	203-276-7093

Provider Business Practice Location Address
First Line	:	1 HOSPITAL PLZ
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-3602
Country	:	US
Telephone Number	:	203-276-1000
Fax Number	:	203-276-7093

Authorized Official
Title or Position	:	EXEC. DIRECTOR - FINANCIAL PLAN & R
Name	:	CRIS COLBERG
Credential	:
Telephone Number	:	203-276-7464

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	08/14/2021

Similar Medicare Providers

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Practice Location Address:

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06902-3602

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Practice Fax: 203-276-4401

1194229112 — AMANDA VEST MD
Practice Location Address:

29 HOSPITAL PLZ STE 603
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06902-3602

Practice Phone: 203-276-5959
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1760068571 — MORGAN BARR MD
Practice Location Address:

1 HOSPITAL PLZ
STAMFORD, CT
06902-3602

Practice Phone: 330-493-4443
Practice Fax:

1790786259 — HENRY YOON M.D.
Practice Location Address:

1 HOSPITAL PLZ
STAMFORD, CT
06902-3602

Practice Phone: 203-276-2270
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1700874435 — DR. EVELYN JANE CUSACK M.D.
Practice Location Address:

29 HOSPITAL PLAZA , SUITE 502
STAMFORD, CT
06902-3602

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1659352946 — DR. BRIAN A TIMKO M.D.
Practice Location Address:

1 HOSPITAL PLZ
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06902-3602

Practice Phone: 203-276-7298
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Directions to “STAMFORD HOSPITAL ” Practice Location

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