Provider Demographics
NPI:1285623116
Name:OLEXO, STEPHEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:OLEXO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2000 MEDICAL PKWY
Mailing Address - Street 2:SUITE 607
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4916
Mailing Address - Country:US
Mailing Address - Phone:410-266-1644
Mailing Address - Fax:410-266-1642
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 607
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21264-4916
Practice Address - Country:US
Practice Address - Phone:410-266-1644
Practice Address - Fax:410-266-1642
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-05-19
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Provider Licenses
StateLicense IDTaxonomies
MDD0058510207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCL4599 110242506OtherRR MEDICARE
MD269900101 400095100Medicaid
MDKJ86AN 61598701OtherCAREFIRST BCBS
DCS3520008OtherCAREFIRST BCBS
MD691L E695Medicare PIN
DCS3520008OtherCAREFIRST BCBS