Basic Information
Provider Information
NPI: 1538214382
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEIN
FirstName: DEBORAH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6934 AVIATION BLVD
Address2: SUITE B
City: GLEN BURNIE
State: MD
PostalCode: 21061
CountryCode: US
TelephoneNumber: 4439490814
FaxNumber:  
Practice Location
Address1: 6934 AVIATION BLVD
Address2: SUITE B
City: GLEN BURNIE
State: MD
PostalCode: 210612593
CountryCode: US
TelephoneNumber: 4439490814
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/24/2007
LastUpdateDate: 08/11/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X220594MAN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XH0065661MDY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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