MEDICARE: MARTY D STOUT

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	1744P3200X	Prosthetics Case Management	431151	MD

General Provider Information

NPI Number	:	1821592080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTY D STOUT

Provider Business Mailing Address
First Line	:	1620 17TH PL SE APT 4
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5548
Country	:	US
Telephone Number	:	202-491-6819
Fax Number	:

Provider Business Practice Location Address
First Line	:	2243 OXON HILL DR
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20020
Country	:	US
Telephone Number	:	202-491-6819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	03/22/2018

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Directions to “ MARTY D STOUT ” Practice Location

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