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NPI Code Detail

MEDICARE: DR. EMILY PAMELA STANFORD DO

MEDICARE:  DR. EMILY PAMELA STANFORD  DO
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
12083A0300XAddiction Medicine (Preventive Medicine) Physician049933CT
2207R00000XInternal Medicine Physician049933CT

General Provider Information

NPI Number : 1114190964
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EMILY PAMELA STANFORD DO
Provider Business Mailing Address
First Line : 112 MANSFIELD AVE
Second Line :
City : WILLIMANTIC
State : CT
Zip : 06226-2045
Country : US
Telephone Number : 860-456-9116
Fax Number :
Provider Business Practice Location Address
First Line : 1290 SILAS DEANE HWY
Second Line :
City : WETHERSFIELD
State : CT
Zip : 06109-4337
Country : US
Telephone Number : 860-679-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2008
Last Update Date : 04/08/2025

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Directions to “ DR. EMILY PAMELA STANFORD DO” Practice Location

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