Provider Demographics
NPI:1053410712
Name:STOCKER, RALPH PETER (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:PETER
Last Name:STOCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:195 EASTERN BLVD
Mailing Address - Street 2:# 201
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1208
Mailing Address - Country:US
Mailing Address - Phone:860-246-4260
Mailing Address - Fax:860-430-9770
Practice Address - Street 1:195 EASTERN BLVD
Practice Address - Street 2:# 201
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1208
Practice Address - Country:US
Practice Address - Phone:860-246-4260
Practice Address - Fax:860-430-9770
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT031761207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83054Medicare UPIN