Healthcare Provider Details

I. General information

NPI: 1275669392
Provider Name (Legal Business Name): AMY STUMP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 HOSPITAL DR SUITE 304
GLEN BURNIE MD
21061-6904
US

IV. Provider business mailing address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-8384
  • Fax:
Mailing address:
  • Phone: 410-787-4594
  • Fax: 410-787-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD65863
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: