Healthcare Provider Details

I. General information

NPI: 1255895512
Provider Name (Legal Business Name): STEVENSON PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ANNAPOLIS RD REAR 105
HALETHORPE MD
21227-3611
US

IV. Provider business mailing address

8039 SOLLEY RD
GLEN BURNIE MD
21060-8610
US

V. Phone/Fax

Practice location:
  • Phone: 410-355-3519
  • Fax: 410-355-4643
Mailing address:
  • Phone: 410-440-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CLAYMON A. STEVENSON II
Title or Position: OWNER
Credential: DPM
Phone: 410-440-7387