MEDICARE: STMD, INC.

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	2084P0800X	Psychiatry Physician	0101035791	VA

General Provider Information

NPI Number	:	1659690105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STMD, INC.

Provider Business Mailing Address
First Line	:	1207 OFFUTT DR
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-2415
Country	:	US
Telephone Number	:	703-533-0070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 OFFUTT DR
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-2415
Country	:	US
Telephone Number	:	703-533-0070
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT TWENTYMAN
Credential	:	M.D.
Telephone Number	:	703-533-0070

Provider Enumeration Date	:	05/24/2010
Last Update Date	:	05/24/2010

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