Provider Demographics
NPI:1063434058
Name:STAMP, CORNELIUS VAN DER MEER (MD)
Entity type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:VAN DER MEER
Last Name:STAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BAY RIDGE AVE
Mailing Address - Street 2:APT A
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-2433
Mailing Address - Country:US
Mailing Address - Phone:410-268-9590
Mailing Address - Fax:
Practice Address - Street 1:821 BAY RIDGE AVE
Practice Address - Street 2:APT A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-2433
Practice Address - Country:US
Practice Address - Phone:410-268-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038107207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE32837Medicare UPIN