Healthcare Provider Details

I. General information

NPI: 1114907029
Provider Name (Legal Business Name): REGINA K STUART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FOUNDERS ST STE 102
WILLIMANTIC CT
06226-2050
US

IV. Provider business mailing address

2518 E DUPONT RD
FORT WAYNE IN
46825-1675
US

V. Phone/Fax

Practice location:
  • Phone: 609-456-2898
  • Fax: 609-456-3078
Mailing address:
  • Phone: 260-432-4400
  • Fax: 260-969-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number57003
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01061211A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: