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General NPI Number Information
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NPI Number | 1487688818
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Entity Type | Individual
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Provider Name | STEPHEN G CONNOLLY MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 4301 N STAR WAY
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City | MODESTO
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State | CA
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Zip | 95356-9262
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Country | US
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Telephone | 209-577-1200
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Fax | 209-577-6517
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Provider Business Mailing Address
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Address Line | 3116 W MARCH LN STE 200
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City | STOCKTON
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State | CA
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Zip | 95219-2370
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Country | US
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Telephone | 209-473-6555
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Fax | 209-473-6544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | G588210
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | G58821
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License Number State | CA
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