Healthcare Provider Details

I. General information

NPI: 1922276476
Provider Name (Legal Business Name): STEVENSON PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ANNAPOLIS RD REAR 105
HALETHORPE MD
21227-3611
US

IV. Provider business mailing address

4000 ANNAPOLIS RD REAR 105
HALETHORPE MD
21227-3611
US

V. Phone/Fax

Practice location:
  • Phone: 410-355-3519
  • Fax:
Mailing address:
  • Phone: 410-439-9185
  • Fax: 410-355-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: CLAYMON A STEVENSON
Title or Position: BUSINESS OWNER
Credential:
Phone: 410-355-3519