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General NPI Number Information
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NPI Number | 1861490104
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Entity Type | Individual
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Provider Name | MARIA N.C. STACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 680 S MAIN ST STE. 205
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City | CHESHIRE
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State | CT
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Zip | 06410-3181
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Country | US
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Telephone | 203-699-9898
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Fax | 203-250-7878
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Provider Business Mailing Address
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Address Line | 680 S MAIN ST STE. 205
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City | CHESHIRE
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State | CT
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Zip | 06410-3181
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Country | US
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Telephone | 203-699-9898
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Fax | 203-250-7878
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 028514
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 028514
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License Number State | CT
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