Provider Demographics
NPI:1538271887
Name:DEGLIN, STUART M (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:M
Last Name:DEGLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:164 OTROBANDO AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2116
Mailing Address - Country:US
Mailing Address - Phone:860-886-0023
Mailing Address - Fax:860-886-0024
Practice Address - Street 1:164 OTROBANDO AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2116
Practice Address - Country:US
Practice Address - Phone:860-886-0023
Practice Address - Fax:860-886-0024
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017694207R00000X
CT17694207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0100017694CT03OtherANTHEM BCBS
2V7779OtherHEALTHNET
B42777Medicare UPIN
2V7779OtherHEALTHNET