Healthcare Provider Details

I. General information

NPI: 1821383514
Provider Name (Legal Business Name): STEPHEN JUDD KRIEG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7785
  • Fax:
Mailing address:
  • Phone: 443-777-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61052896
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125059742
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number278997
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0094427
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: