Organization
STAFFORD MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SULTAN ALAM QURAISHI M.D. (MEDICAL DIRECTOR)
(860) 558-3624
Entity
Organization
Contact information
Practice address
146 MAIN ST, SOMERS, CT 06071-1825
(860) 749-8018
(860) 316-4015
Mailing address
146 MAIN ST, SOMERS, CT 06071-1825
(860) 749-8018
(860) 316-4015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30076
CT
208600000X
Surgery Physician
30076
CT
363L00000X
Nurse Practitioner
5393
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000898346
UNITED HEALTHCARE
CT
01
—
010030076CT04
ANTHEM
CT
01
—
130076400
BLUE CARE FAMILY PLAN
CT
05
—
217079
—
CT
01
—
2V4565
HEALTHNET
CT
01
—
4245029
AETNA
CT
01
—
5861484
CIGNA
CT
01
—
781160
CONNECTICARE
CT
01
—
HAS028
OXFORD
CT
Enumeration date
03/08/2007
Last updated
01/29/2015
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