Healthcare Provider Details

I. General information

NPI: 1194771378
Provider Name (Legal Business Name): MARTHA W STEVENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST # G-1509 HOSPITAL BASED @ JHH-BLOOMBERG CHILDREN'S CENTER
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

1800 ORLEANS ST # G-1509 HOSPITAL BASED @ JHH-BLOOMBERG CHILDREN'S CENTER
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6146
  • Fax: 410-614-7339
Mailing address:
  • Phone: 410-955-6146
  • Fax: 410-614-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberD0044281
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: