Healthcare Provider Details

I. General information

NPI: 1750515565
Provider Name (Legal Business Name): CAMPBELL L STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SOUTH ROAD
FARMINGTON CT
06032
US

IV. Provider business mailing address

21 SOUTH ROAD
FARMINGTON CT
06032
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4600
  • Fax: 860-679-3207
Mailing address:
  • Phone: 860-679-4600
  • Fax: 860-679-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD60454651
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number061363
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD60454651
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: