Healthcare Provider Details

I. General information

NPI: 1013976091
Provider Name (Legal Business Name): STEPHANIE LYNN DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S PACA ST LOWER LEVEL
BALTIMORE MD
21201-1771
US

IV. Provider business mailing address

3400 BOX HILL CORPORATE CENTER DR STE 100
ABINGDON MD
21009-1290
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8792
  • Fax: 410-328-0716
Mailing address:
  • Phone: 800-777-7904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0061643
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: