Healthcare Provider Details

I. General information

NPI: 1639556350
Provider Name (Legal Business Name): ROBERT CHASE STOCKTON D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 N MAIN STREET EXT STE 2002ND
WALLINGFORD CT
06492-2434
US

IV. Provider business mailing address

863 N MAIN STREET EXT STE 2002ND
WALLINGFORD CT
06492-2434
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3280
  • Fax:
Mailing address:
  • Phone: 32-653-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberS4692
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: