Healthcare Provider Details

I. General information

NPI: 1629711627
Provider Name (Legal Business Name): MEDSTAR MEDICAL GROUP II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12158 CENTRAL AVE
MITCHELLVILLE MD
20721-1932
US

IV. Provider business mailing address

2000 15TH ST N STE 600
ARLINGTON VA
22201-2900
US

V. Phone/Fax

Practice location:
  • Phone: 301-430-2700
  • Fax:
Mailing address:
  • Phone: 703-558-1400
  • Fax: 703-558-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SCHNEIDER
Title or Position: VP
Credential:
Phone: 702-558-1403