1194771378 NPI number — DR. MARTHA W STEVENS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194771378 NPI number — DR. MARTHA W STEVENS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENS
Provider First Name:
MARTHA
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194771378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 ORLEANS ST # G-1509
Provider Second Line Business Mailing Address:
HOSPITAL BASED @ JHH-BLOOMBERG CHILDREN'S CENTER
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21287-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-955-6146
Provider Business Mailing Address Fax Number:
410-614-7339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 ORLEANS ST # G-1509
Provider Second Line Business Practice Location Address:
HOSPITAL BASED @ JHH-BLOOMBERG CHILDREN'S CENTER
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287-0010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-955-6146
Provider Business Practice Location Address Fax Number:
410-614-7339
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0204X , with the licence number:  D0044281 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 781700401914 . This is a "CCN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 219021401 . This is a "MEDICAID INDIVIDUAL #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 766621700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 257368Y18 . This is a "PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 003000261Q . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




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