Healthcare Provider Details

I. General information

NPI: 1174508816
Provider Name (Legal Business Name): STEPHEN PAUL HYLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 PORTER ST
FREDERICK MD
21702-9254
US

IV. Provider business mailing address

1434 PORTER ST
FREDERICK MD
21702-9254
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-2003
  • Fax:
Mailing address:
  • Phone: 301-619-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50639
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number50639
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: