Healthcare Provider Details

I. General information

NPI: 1316590706
Provider Name (Legal Business Name): MEDSTAR MEDICAL GROUP II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD STE 101
BALTIMORE MD
21239-2945
US

IV. Provider business mailing address

2000 15TH ST N STE 600
ARLINGTON VA
22201-2900
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-2876
  • Fax: 443-444-1487
Mailing address:
  • Phone: 703-558-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE SCHNEIDER
Title or Position: VP
Credential:
Phone: 703-558-1403