MEDICARE: STEPHEN R WOODWORTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	044476	CT
2	207UN0901X	Nuclear Cardiology Physician	044476	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010044476CT01	OTHER	CT	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043283302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN R WOODWORTH MD

Provider Business Mailing Address
First Line	:	2 IVY BROOK RD
Second Line	:	SUITE 205
City	:	SHELTON
State	:	CT
Zip	:	06484-6416
Country	:	US
Telephone Number	:	203-922-9466
Fax Number	:	203-922-9477

Provider Business Practice Location Address
First Line	:	2 IVY BROOK RD
Second Line	:	SUITE 205
City	:	SHELTON
State	:	CT
Zip	:	06484-6416
Country	:	US
Telephone Number	:	203-922-9466
Fax Number	:	203-922-9477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	02/07/2013

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