Healthcare Provider Details

I. General information

NPI: 1467124099
Provider Name (Legal Business Name): MEDSTAR MEDICAL GROUP II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MALCOLM DR STE 200
WESTMINSTER MD
21157-6174
US

IV. Provider business mailing address

3007 TILDEN ST NW STE 5N
WASHINGTON DC
20008-3030
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-8800
  • Fax:
Mailing address:
  • Phone:
  • 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: VICE PRESIDENT
Credential:
Phone: 702-558-1403