Provider Demographics
NPI:1487754933
Name:PROSHAN, STEVEN GERALD (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:GERALD
Last Name:PROSHAN
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 1:2002 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-573-1699
Mailing Address - Fax:410-573-5311
Practice Address - Street 1:2002 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 360
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-573-1699
Practice Address - Fax:410-573-5311
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056357208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KCT5OtherBSMD
75440001OtherBSDC
G09030Medicare UPIN
KCT5OtherBSMD