MEDICARE: MEDSTAR MEDICAL GROUP II LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1578379327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAR MEDICAL GROUP II LLC

Provider Business Mailing Address
First Line	:	3007 TILDEN ST NW STE 5N
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-3030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6862 ELM ST STE 800A
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3868
Country	:	US
Telephone Number	:	703-663-4737
Fax Number	:	202-877-8010

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	STEPHANIE SCHNEIDER
Credential	:
Telephone Number	:	703-558-1403

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	12/06/2024

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