Individual
KEVIN F STAVELEY-OCARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
263 FARMINGTON AVENUE, FARMINGTON, CT 06030-8063
(860) 679-8080
(860) 679-1340
Mailing address
263 FARMINGTON AVENUE, FARMINGTON, CT 06030-8063
(860) 679-8080
(860) 679-1340
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
076526
CT
208600000X
Surgery Physician
2015030565
MO
208600000X
Surgery Physician
MD071461L
PA
2086X0206X
Surgical Oncology Physician
2015030565
MO
2086X0206X
Surgical Oncology Physician
35558
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018125830001
—
PA
Enumeration date
04/25/2006
Last updated
03/05/2024
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