Individual
DR. JENNIE THOMAS STANFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
69 GROVE ST, NEW CANAAN, CT 06840-5325
(844) 359-8363
(833) 929-3520
Mailing address
69 GROVE ST, NEW CANAAN, CT 06840-5325
(844) 359-8363
(833) 929-3520
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1043889967
NY
261QM2500X
Medical Specialty Clinic/Center
1992372403
CT
261QM2500X
Medical Specialty Clinic/Center
1992372403
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07129501
—
MS
Enumeration date
04/11/2016
Last updated
07/16/2024
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