MEDICARE: DR. DAVID STANFORD LOUDER III 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	2080N0001X	Neonatal-Perinatal Medicine Physician	D0063994	MD

General Provider Information

NPI Number	:	1750382875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID STANFORD LOUDER III M.D.

Provider Business Mailing Address
First Line	:	200 MEMORIAL AVE
Second Line	:	VP OF PHYSICIAN ENTERPRISES, CHC
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5726
Country	:	US
Telephone Number	:	410-871-6475
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEMORIAL AVE
Second Line	:	VP OF PHYSICIAN ENTERPRISES, CHC
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5726
Country	:	US
Telephone Number	:	410-871-6475
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	12/19/2011

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