Healthcare Provider Details

I. General information

NPI: 1669230413
Provider Name (Legal Business Name): MARK GORDON STEIGERWALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 TRUMPETER RD
COLUMBIA MD
21044-2314
US

IV. Provider business mailing address

9030 OLD ANNAPOLIS RD STE A
COLUMBIA MD
21045-1990
US

V. Phone/Fax

Practice location:
  • Phone: 410-313-6965
  • Fax:
Mailing address:
  • Phone: 410-740-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP14555
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: