Healthcare Provider Details

I. General information

NPI: 1700319464
Provider Name (Legal Business Name): STEPHEN WILLIAM POURNARAS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL RD STE 201
PRINCE FREDERICK MD
20678-4045
US

IV. Provider business mailing address

110 HOSPITAL RD STE 201
PRINCE FREDERICK MD
20678-4045
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-1343
  • Fax:
Mailing address:
  • Phone: 410-535-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberD0107745
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0107745
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: