Healthcare Provider Details

I. General information

NPI: 1194023374
Provider Name (Legal Business Name): STEPHEN J MCKENNA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 07/31/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 THOMAS JOHNSON DRIVE SUITE 7
FREDERICK MD
21702-4503
US

IV. Provider business mailing address

187 THOMAS JOHNSON DRIVE SUITE 7
FREDERICK MD
21702-4503
US

V. Phone/Fax

Practice location:
  • Phone: 240-457-4605
  • Fax: 240-457-4631
Mailing address:
  • Phone: 240-457-4605
  • Fax: 240-457-4631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD31422
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN J MCKENNA
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 301-651-0023