MEDICARE: STEPHAN A BART SR. M.D.

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	207Q00000X	Family Medicine Physician	D0064938	MD
2	207Q00000X	Family Medicine Physician	ME64842	FL

General Provider Information

NPI Number	:	1225014459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN A BART SR. M.D.

Provider Business Mailing Address
First Line	:	10403 WETHERBURN RD
Second Line	:
City	:	WOODSTOCK
State	:	MD
Zip	:	21163
Country	:	US
Telephone Number	:	352-586-8547
Fax Number	:

Provider Business Practice Location Address
First Line	:	10403 WETHERBURN RD
Second Line	:
City	:	WOODSTOCK
State	:	MD
Zip	:	21163
Country	:	US
Telephone Number	:	352-586-8547
Fax Number	:

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	06/19/2012

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