Healthcare Provider Details

I. General information

NPI: 1467331769
Provider Name (Legal Business Name): MEDSTAR MEDICAL GROUP II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 PRINCE PHILIP DR
OLNEY MD
20832-1514
US

IV. Provider business mailing address

3007 TILDEN ST NW
WASHINGTON DC
20008-3008
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-8882
  • Fax:
Mailing address:
  • Phone: 703-558-1403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

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