Individual
KATHRYN E STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15 WOOD CREST DR, OLD LYME, CT 06371-2840
(404) 932-9109
Mailing address
15 WOOD CREST DR, OLD LYME, CT 06371-2840
(404) 932-9109
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
57186
CT
Other
Enumeration date
06/13/2006
Last updated
12/23/2021
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