Healthcare Provider Details

I. General information

NPI: 1053874321
Provider Name (Legal Business Name): MEDSTAR MEDICAL GROUP II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 PRINCE PHILIP DR
OLNEY MD
20832-1514
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 301-774-8860
  • Fax: 301-774-8899
Mailing address:
  • Phone: 703-558-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

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