MEDICARE: DR. JAMES STONEWALL DORSEY MD

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
1	208D00000X	General Practice Physician	D39411	MD

General Provider Information

NPI Number	:	1174748271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES STONEWALL DORSEY MD

Provider Business Mailing Address
First Line	:	122 LANGLEY RD N
Second Line	:	SUITE B
City	:	GLEN BURNIE
State	:	MD
Zip	:	21060-6539
Country	:	US
Telephone Number	:	410-222-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 LANGLEY RD N
Second Line	:	SUITE B
City	:	GLEN BURNIE
State	:	MD
Zip	:	21060-6539
Country	:	US
Telephone Number	:	410-222-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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