# STAFFORD MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518098698
- **Authorized official:** DR. SULTAN ALAM QURAISHI M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (860) 558-3624

## Contact information

- **Practice address:** 146 MAIN ST, SOMERS, CT 06071-1825
- **Practice address phone:** (860) 749-8018
- **Practice address fax:** (860) 316-4015
- **Mailing address:** 146 MAIN ST, SOMERS, CT 06071-1825
- **Mailing address phone:** (860) 749-8018
- **Mailing address fax:** (860) 316-4015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 30076 | CT | Yes |
| 208600000X | Surgery Physician | 30076 | CT | — |
| 363L00000X | Nurse Practitioner | 5393 | CT | — |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 01/29/2015