Healthcare Provider Details

I. General information

NPI: 1164533584
Provider Name (Legal Business Name): SUSAN DEBORAH STEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/03/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW FL 9
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW FL 9
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-463-8548
  • Fax: 202-463-0476
Mailing address:
  • Phone: 202-463-8548
  • Fax: 202-463-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberM30567
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD11008
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: