Provider Demographics
NPI:1194771378
Name:STEVENS, MARTHA W (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:W
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1800 ORLEANS ST # G-1509
Mailing Address - Street 2:HOSPITAL BASED @ JHH-BLOOMBERG CHILDREN'S CENTER
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0010
Mailing Address - Country:US
Mailing Address - Phone:410-955-6146
Mailing Address - Fax:410-614-7339
Practice Address - Street 1:1800 ORLEANS ST # G-1509
Practice Address - Street 2:HOSPITAL BASED @ JHH-BLOOMBERG CHILDREN'S CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-955-6146
Practice Address - Fax:410-614-7339
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00442812080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD781700401914OtherCCN
MD219021401OtherMEDICAID INDIVIDUAL #
MD766621700Medicaid
MD257368Y18OtherPTAN
003000261QOtherHUMANA
MD219021401OtherMEDICAID INDIVIDUAL #