Healthcare Provider Details

I. General information

NPI: 1780678227
Provider Name (Legal Business Name): STUART MARCUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST ST. VINCENT'S MEDICAL CENTER
BRIDGEPORT CT
06606-4201
US

IV. Provider business mailing address

2800 MAIN ST ST. VINCENT'S MEDICAL CENTER
BRIDGEPORT CT
06606-4201
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-6101
  • Fax: 203-581-6587
Mailing address:
  • Phone: 203-576-6101
  • Fax: 203-581-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number175417
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number044473
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: