Basic Information
| Provider Information | |||||||||
| NPI: | 1114109782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOUNTAIN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 TIMBER SPRINGS CT | ||||||||
| Address2: | |||||||||
| City: | REISTERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211365844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177813100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2391 GREENSPRING DR | ||||||||
| Address2: | |||||||||
| City: | LUTHERVILLE TIMONIUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210933166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007777904 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | D0067027 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 415386300 | 05 | MD | MEDICAID |