Healthcare Provider Details

I. General information

NPI: 1336134576
Provider Name (Legal Business Name): GEORGE M STOHR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST DEPARTMENT OF RADIOLOGY
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

1000 ASYLUM AVE SUITE 3201E
HARTFORD CT
06105-1770
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4092
  • Fax: 860-714-8808
Mailing address:
  • Phone: 860-525-3322
  • Fax: 860-714-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number041188
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: