Healthcare Provider Details

I. General information

NPI: 1417002858
Provider Name (Legal Business Name): BAUMAN AND STOLERU MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 CONNECTICUT AVE NW
WASHINGTON DC
20008-1155
US

IV. Provider business mailing address

3553 16TH ST NW
WASHINGTON DC
20010-3041
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-4008
  • Fax: 202-328-0565
Mailing address:
  • Phone: 202-387-8900
  • Fax: 202-328-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: AMY LYNN ROSENSTADT
Title or Position: MANAGER
Credential:
Phone: 202-387-8900