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General NPI Number Information
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NPI Number | 1174150411
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Entity Type | Individual
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Provider Name | STEPHANIE DIANA CRIMMEL MD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 22 S GREENE ST RM N3E09
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City | BALTIMORE
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State | MD
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Zip | 21201-1544
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Country | US
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Telephone | 410-328-6110
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE FL 2
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-2704
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | D0099883
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License Number State | MD
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