Healthcare Provider Details

I. General information

NPI: 1790273068
Provider Name (Legal Business Name): ALEXANDRA MARY STOUGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 RIVERSIDE AVE
WESTPORT CT
06880-4821
US

IV. Provider business mailing address

327 RIVERSIDE AVE
WESTPORT CT
06880-4821
US

V. Phone/Fax

Practice location:
  • Phone: 203-221-3030
  • Fax: 203-221-3131
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD473217
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83547
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: