Organization
THE GREENWICH MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STUART MCCALLEY MD (PRESIDENT)
(203) 869-6960
Entity
Organization
Contact information
Practice address
75 HOLLY HILL LN, GREENWICH, CT 06830-6098
(203) 869-6960
Mailing address
75 HOLLY HILL LN, GREENWICH, CT 06830-6098
(203) 869-6960
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
CT
207RC0000X
Cardiovascular Disease Physician
—
CT
207RP1001X
Pulmonary Disease Physician
—
CT
363AM0700X
Medical Physician Assistant
001163
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004393948
—
CT
01
—
471501
AETNA HMO GROUP NUMBER
CT
01
—
8170815
AETNA PPO GROUP NUMBER
CT
01
—
C30447
RAILROAD MEDICARE GROUP #
CT
Enumeration date
11/22/2006
Last updated
06/17/2009
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