Provider Demographics
NPI:1427042167
Name:SMALDORE, STEPHEN GERARD (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GERARD
Last Name:SMALDORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 OLD EMMORTON RD STE 218
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6189
Mailing Address - Country:US
Mailing Address - Phone:443-371-4940
Mailing Address - Fax:443-371-4941
Practice Address - Street 1:2227 OLD EMMORTON RD STE 218
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6189
Practice Address - Country:US
Practice Address - Phone:443-371-4940
Practice Address - Fax:443-371-4941
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH40583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD199LOtherMEDICARE GROUP
MD348761000Medicaid
F22968Medicare UPIN