Healthcare Provider Details

I. General information

NPI: 1366347650
Provider Name (Legal Business Name): MEDSTAR MEDICAL GROUP II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 JOHN MCCORMACK RD NE
WASHINGTON DC
20064-0001
US

IV. Provider business mailing address

2233 WISCONSIN AVE NW STE 420
WASHINGTON DC
20007-4122
US

V. Phone/Fax

Practice location:
  • Phone: 202-416-2110
  • Fax: 202-416-2011
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE SCHNEIDER
Title or Position: VICE PRESIDENT
Credential:
Phone: 703-558-1403