Healthcare Provider Details

I. General information

NPI: 1326594110
Provider Name (Legal Business Name): MICHELLE STULBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4927 AUBURN AVE SUITE 100
BETHESDA MD
20814-2641
US

IV. Provider business mailing address

6441 MELLOW WINE WAY
COLUMBIA MD
21044-6027
US

V. Phone/Fax

Practice location:
  • Phone: 301-943-9293
  • Fax:
Mailing address:
  • Phone: 301-219-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: