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NPI Code Detail

MEDICARE: MR. MICHAEL EVAN STAHLY II LGSW

MEDICARE:  MR. MICHAEL EVAN STAHLY II LGSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker22134MD

General Provider Information

NPI Number : 1174077820
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL EVAN STAHLY II LGSW
Provider Business Mailing Address
First Line : 5410 LIGHTNING VIEW RD
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-2244
Country : US
Telephone Number : 301-801-2418
Fax Number :
Provider Business Practice Location Address
First Line : 6310 STEVENS FOREST RD
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-1036
Country : US
Telephone Number : 301-801-2418
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2016
Last Update Date : 08/11/2016

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Directions to “ MR. MICHAEL EVAN STAHLY II LGSW” Practice Location

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