PHILLIP M STARK MD (Credential# 146767) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
PHILLIP M STARK MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0013088. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is Woodland Anesthesia Association, Hartford, CT 06105. The current status is active.
| Licensee Name | PHILLIP M STARK MD |
| Credential ID | 146767 |
| Credential Number | CSP.0013088 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
Woodland Anesthesia Association Hartford CT 06105 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-14 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 545878 | 1.026199 | Physician/Surgeon | 1985-03-06 | 2019-10-01 - 2020-09-30 | ACTIVE |
| Street Address | WOODLAND ANESTHESIA ASSOCIATION |
| City | HARTFORD |
| State | CT |
| Zip Code | 06105 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Hartford Community Loan Fund | 215 Garden Street, Hartford, CT 06105 | Public Charity | 2019-06-01 ~ 2020-05-31 |
| Kathleen C Hobart | 81 Fern Street, Hartford, CT 06105 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Khadija Seidi | 196 Laurel St, Hartford, CT 06105 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Stuart W Alpert | 200 N Beacon St, Hartford, CT 06105 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
| Christina Perez | 4 Atwood Street, Hartford, CT 06105 | Marital and Family Therapist | 2020-07-01 ~ 2021-06-30 |
| Ashley Ameena Bachan | 25 Owen Street, Hartford, CT 06105 | Licensed Practical Nurse | 2020-06-01 ~ 2021-05-31 |
| Dhruti Anilkant Mankodi | Hospitalist Department, Hartford, CT 06105 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Jacqueline Alexandra Raymond | 24 Owen Street, Hartford, CT 06105 | Esthetician | 2020-06-22 ~ 2021-10-31 |
| Hortense Bates | 48-50 Atwood Street, Hartford, CT 06105 | Medication Administration Certification | 2020-08-20 ~ 2022-08-19 |
| Nicolas Archambault | 169 Sigourney Street, Hartford, CT 06105 | Emergency Medical Technician | ~ |
| Find all Licenses in zip 06105 | |||
| City | HARTFORD |
| Zip Code | 06105 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + HARTFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Phillip Brewer Md | 275 Mount Carmel Ave, Hamden, CT 06518-1905 | Controlled Substance Registration for Practitioner | 2013-04-19 ~ 2015-02-28 |
| Jack Stark | 132 Main St, Danbury, CT 06810 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Tom E Stark Do | 780 Litchfield Street, Torrington, CT 06790 | Controlled Substance Registration for Practitioner | 2002-03-01 ~ 2003-02-28 |
| Barry I Stark | 337 Notch Hill Rd, North Branford, CT 06471 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Sonja L Stark Aprn | 1004 New Windsor Loop, Sun City Center, FL 33573 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Phillip Joseph | 20 York St, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2019-05-16 ~ 2021-02-28 |
| Gabrielle Phillip | 20 York St, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phillip Chappell | 153 Elm Street, Guilford, CT 06437 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phillip Ruisi | 439 Mill Hill Ave, Bridgeport, CT 06610-2866 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phillip Werman | 171d Clark St, Milford, CT 06460 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).