Healthcare Provider Details

I. General information

NPI: 1831183169
Provider Name (Legal Business Name): PRINCESS ANNE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30434 MOUNT VERNON RD
PRINCESS ANNE MD
21853-1400
US

IV. Provider business mailing address

30434 MOUNT VERNON RD
PRINCESS ANNE MD
21853-1400
US

V. Phone/Fax

Practice location:
  • Phone: 410-651-0350
  • Fax: 410-651-4857
Mailing address:
  • Phone: 410-651-0350
  • Fax: 410-651-4857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES DONALD STEGMAN JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 410-651-0350