=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659688703
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN PAUL CREEKMORE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2010
-----------------------------------------------------
Last Update Date | 09/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9012 MOUNTAINBERRY CT
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21702-3404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-663-4970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9012 MOUNTAINBERRY CT
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21702-3404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-846-1100
-----------------------------------------------------
Fax | 301-846-5429
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | D0034099
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------