Healthcare Provider Details

I. General information

NPI: 1467039438
Provider Name (Legal Business Name): SOFIA BERMUDEZ STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N EAST PLZ
NORTH EAST MD
21901-3633
US

IV. Provider business mailing address

103 N EAST PLZ
NORTH EAST MD
21901-3633
US

V. Phone/Fax

Practice location:
  • Phone: 410-287-5570
  • Fax:
Mailing address:
  • Phone: 410-287-5570
  • Fax: 410-287-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0026827
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0100091
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: