Basic Information
| Provider Information | |||||||||
| NPI: | 1255477261 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANFIELD | ||||||||
| FirstName: | CATHY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 E TIMONIUM RD | ||||||||
| Address2: | |||||||||
| City: | TIMONIUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210933344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109555144 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 S DUNDALK AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | DUNDALK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212224273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102200720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | R086517 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 363LA2100X | R086517 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 099013200 | 05 | MD | MEDICAID |