Healthcare Provider Details

I. General information

NPI: 1659688703
Provider Name (Legal Business Name): STEPHEN PAUL CREEKMORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 MOUNTAINBERRY CT
FREDERICK MD
21702-3404
US

IV. Provider business mailing address

9012 MOUNTAINBERRY CT
FREDERICK MD
21702-3404
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-4970
  • Fax:
Mailing address:
  • Phone: 301-846-1100
  • Fax: 301-846-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD0034099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: