Provider Demographics
NPI:1386892354
Name:STOLZENBERG, JONATHAN BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BRUCE
Last Name:STOLZENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1603
Mailing Address - Country:US
Mailing Address - Phone:860-521-5685
Mailing Address - Fax:
Practice Address - Street 1:32 ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1603
Practice Address - Country:US
Practice Address - Phone:860-521-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021676208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT021676OtherLICENSE TO PRACTICE MEDICINE
CT021676OtherLICENSE TO PRACTICE MEDICINE