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Organization

MOUNT CARMEL INTERNAL MEDICINE AND GERIATRICS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARIA N.C. STACK M.D. (PRESIDENT)
(203) 699-9898
Entity
Organization

Contact information

Practice address
680 S MAIN ST, SUITE 205, CHESHIRE, CT 06410-3181
(203) 699-9898
(203) 250-7878
Mailing address
5000 BIRCH ST, NEWPORT BEACH, CA 92660-2127
(301) 990-3995
(702) 447-8174

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001285148
CT
Enumeration date
07/14/2005
Last updated
07/21/2022
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