MEDICARE: STEVENSON PODIATRY LLC

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	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255895512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVENSON PODIATRY LLC

Provider Business Mailing Address
First Line	:	8039 SOLLEY RD
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21060-8610
Country	:	US
Telephone Number	:	410-440-7387
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 ANNAPOLIS RD REAR 105
Second Line	:
City	:	HALETHORPE
State	:	MD
Zip	:	21227-3611
Country	:	US
Telephone Number	:	410-355-3519
Fax Number	:	410-355-4643

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLAYMON A. STEVENSON II
Credential	:	DPM
Telephone Number	:	410-440-7387

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	01/30/2019

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Directions to “STEVENSON PODIATRY LLC ” Practice Location

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