Healthcare Provider Details

I. General information

NPI: 1083934541
Provider Name (Legal Business Name): LILJA S. STEFANSSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N HOWARD ST
BALTIMORE MD
21201-3610
US

IV. Provider business mailing address

330 N HOWARD ST
BALTIMORE MD
21201-3610
US

V. Phone/Fax

Practice location:
  • Phone: 410-576-1414
  • Fax:
Mailing address:
  • Phone: 410-576-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0096508
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number267701
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116022299
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: