Basic Information
| Provider Information | |||||||||
| NPI: | 1083247894 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDSTAR MEDICAL GROUP II LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 15TH ST N STE 600 | ||||||||
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| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222012900 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9101 FRANKLIN SQUARE DRIVE | ||||||||
| Address2: | STE 200, MEDICAL ARTS BUILDING | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212374072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437776788 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2020 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHNEIDER | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 7025581403 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MEDSTAR MEDICAL GROUP II LLC | ||||||||
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| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.