Healthcare Provider Details

I. General information

NPI: 1003209495
Provider Name (Legal Business Name): STEPHANIE M. DUNBAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 FOREST OAK CT
BEL AIR MD
21015-6170
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 410-688-7792
  • Fax: 410-836-8064
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE MILLER DUNBAR
Title or Position: PRESIDENT
Credential: MSN, CRNA
Phone: 410-688-7792