Healthcare Provider Details

I. General information

NPI: 1528011129
Provider Name (Legal Business Name): VICTORIA RUTH STAIMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 MAPLE LAWN BLVD STE 210
FULTON MD
20759-2565
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 301-725-0134
  • Fax: 301-725-0135
Mailing address:
  • Phone: 410-581-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0054694
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: