Healthcare Provider Details

I. General information

NPI: 1205819216
Provider Name (Legal Business Name): STANFORD I LAMBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 GARDENVIEW RD
BALTIMORE MD
21208-1514
US

IV. Provider business mailing address

3704 GARDENVIEW RD
BALTIMORE MD
21208-1514
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-4297
  • Fax: 410-486-5536
Mailing address:
  • Phone: 410-484-4297
  • Fax: 410-486-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD15895
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: