MEDICARE: DR. STEPHEN JOSEPH PHELAN M.D.

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	207R00000X	Internal Medicine Physician	12629	NH
2	207R00000X	Internal Medicine Physician	242245-1	NY
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	046242	CT

General Provider Information

NPI Number	:	1326142332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JOSEPH PHELAN M.D.

Provider Business Mailing Address
First Line	:	91 VOLUNTOWN RD
Second Line	:
City	:	PAWCATUCK
State	:	CT
Zip	:	06379-1366
Country	:	US
Telephone Number	:	860-599-5477
Fax Number	:	860-865-2389

Provider Business Practice Location Address
First Line	:	91 VOLUNTOWN RD
Second Line	:
City	:	PAWCATUCK
State	:	CT
Zip	:	06379-1366
Country	:	US
Telephone Number	:	860-599-5477
Fax Number	:	860-865-2389

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	02/07/2017

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