Healthcare Provider Details

I. General information

NPI: 1275987901
Provider Name (Legal Business Name): STEPHANIE STRAUSS REGENOLD M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 N CHARLES ST STE A
BALTIMORE MD
21210-2642
US

IV. Provider business mailing address

4502 N CHARLES ST STE A
BALTIMORE MD
21210-2642
US

V. Phone/Fax

Practice location:
  • Phone: 410-617-5055
  • Fax: 410-617-2173
Mailing address:
  • Phone: 410-617-5055
  • Fax: 410-617-2173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0041148
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: