Provider Demographics
NPI:1083247894
Name:MEDSTAR MEDICAL GROUP II LLC
Entity type:Organization
Organization Name:MEDSTAR MEDICAL GROUP II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-558-1403
Mailing Address - Street 1:3007 TILDEN ST NW STE 5N
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9101 FRANKLIN SQUARE DRIVE
Practice Address - Street 2:STE 200, MEDICAL ARTS BUILDING
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4072
Practice Address - Country:US
Practice Address - Phone:443-777-6788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSTAR MEDICAL GROUP II LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty