Healthcare Provider Details

I. General information

NPI: 1134143498
Provider Name (Legal Business Name): FRAY DYLAN STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST HARVEY 319
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

600 N WOLFE ST HARVEY 319
BALTIMORE MD
21287-0005
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-2960
  • Fax: 410-502-5314
Mailing address:
  • Phone: 410-955-2960
  • Fax: 410-502-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0053844
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberD53844
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: