Healthcare Provider Details

I. General information

NPI: 1659698769
Provider Name (Legal Business Name): STEPHANIE CHEN BLOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE YUCHING CHEN MD

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 INTERNATIONAL DR STE 210
SILVER SPRING MD
20906-1550
US

IV. Provider business mailing address

8555 16TH ST SUITE 310
SILVER SPRING MD
20910-2816
US

V. Phone/Fax

Practice location:
  • Phone: 301-562-7200
  • Fax:
Mailing address:
  • Phone: 301-563-7198
  • Fax: 301-563-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number48112
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0082023
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7100364420
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: